title: Pretransplant prophylactic rituximab to prevent Epstein-Barr virus (EBV) viremia in EBV-seronegative kidney transplant recipients from EBV-seropositive donors: results of a pilot study.
abstract: BACKGROUND
  Because of the strikingly increased risk of post-transplant lymphoproliferative disorder (PTLD) in Epstein-Barr virus (EBV)-seronegative kidney transplant recipients (KTRs) from EBV-seropositive donors-EBV(D+R-), special strategies need to be defined to prevent EBV transmission and EBV viremia.
  
  
  METHODS
  We studied all KTRs at our center between 2008 and 2012. Seventeen of 402 KTRs (4.2%) were identified as EBV(D+R-), among which 5 KTRs received kidneys from living donors and 12 KTRs from deceased donors. KTRs undergoing living donation were treated with a single dose of rituximab 4 weeks prior to transplantation. Assessment of EBV seroconversion and EBV viremia was performed.
  
  
  RESULTS
  Among 12 EBV-seronegative KTRs from deceased donors, all 12 KTRs (100%) showed EBV seroconversion, 7 KTRs (58%) showed active EBV viremia, and 1 KTR (8%) developed PTLD. In comparison, 3 of 5 KTRs from living donors, who received pretransplant rituximab, remained EBV-seronegative post transplantation, and no KTR developed EBV viremia (P<.05). All KTRs who received pretransplant rituximab showed excellent allograft function, with no increase in infections or malignancies.
  
  
  CONCLUSIONS
  Our data suggest that rituximab-mediated elimination of B cells may prevent transmission of EBV to the recipient, as EBV persistence requires the establishment of a latent infection in recipient B cells. Pretransplant rituximab may prove useful to prevent primary EBV infection in EBV-seronegative KTRs.
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany.|Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachtner
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany.|Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Reinke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts / Q000187:drug effects / Q000821:virology*; D001402:B-Lymphocytes / Q000187:drug effects; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000821:virology; D004854:Herpesvirus 4, Human / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage / Q000627:therapeutic use*; D012698:Serologic Tests; D014019:Tissue Donors; D066027:Transplant Recipients; D019172:Transplantation Conditioning / Q000379:methods*; D014766:Viremia / Q000517:prevention & control* / Q000821:virology; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D000069283:Rituximab
keywords: 
  CMV
  ; 
  EBV
  ; 
  PTLD
  ; renal transplantation; rituximab