title: Epstein-Barr virus and renal transplantation.
abstract: Epstein-Barr virus (EBV) is a gamma herpesvirus associated with diseases ranging from asymptomatic viremia to post-transplant malignancies in kidney transplant recipients. EBV specifically is associated with post-transplantation lymphoproliferative disorder (PTLD), in kidney transplant recipients, with increased risk in EBV seronegative patients with EBV seropositive donors on intensified immunosuppression. The diagnosis of PTLD relies on clinical suspicion plus tissue biopsy with polymerase chain reaction (PCR) testing of blood currently used for risk determination in high-risk recipients. Therapeutic strategies for PTLD include reduction of immunosuppression, chemotherapy and rituximab, and consideration of sirolimus-based immunosuppression. Antivirals such as ganciclovir are used to prevent reactivation of cytomegalovirus and other herpes viruses but are not onco-therapeutic. Radiation therapy or surgery is indicated for bulky, disseminated or recalcitrant disease. Prognosis varies depending on the type of malignancy identified and stage of disease.
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
authors.forename: Jade
authors.initials: J
authors.lastname: Le
authors.affiliation: Johns Hopkins Medical Institute, 1830 East Monument Street, Room 450D, Baltimore, MD 21287, United States.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Durand
authors.affiliation: Dallas Renal Group, 3571 W. Wheatland Road, Suite 101, Dallas, TX 75237, United States.
authors.forename: Irfan
authors.initials: I
authors.lastname: Agha
authors.affiliation: Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States. Electronic address: dbrennan@wustl.edu.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
mesh_terms: D064591:Allografts; D015897:Comorbidity; D046148:Donor Selection; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006084:Graft Rejection / Q000821:virology*; D006085:Graft Survival; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D011322:Primary Prevention / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D016036:Seroepidemiologic Studies; D014019:Tissue Donors; D014766:Viremia / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery