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Quantitative Epstein–Barr virus shedding and its correlation with the risk of post‐transplant lymphoproliferative disorder
Author(s) -
Holman Carol J.,
Karger Amy B.,
Mullan Beth D.,
Brundage Richard C.,
Balfour Henry H.
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2012.01608.x
Subject(s) - medicine , lymphoproliferative disorders , post transplant lymphoproliferative disorder , transplantation , gastroenterology , virus , viral shedding , immunosuppression , immunology , real time polymerase chain reaction , epstein–barr virus , herpesviridae , viral disease , lymphoma , biology , biochemistry , gene
We postulated that quantitative monitoring of E pstein– B arr virus ( EBV ) shedding after transplantation could distinguish EBV ‐associated illnesses and predict clinical outcome. EBV DNA was measured in solid organ ( SOT ) and hematopoietic cell transplants ( HCT ) using our own real‐time T aq M an EBV PCR . The proportion of patients who had EBV DNA emia post‐transplant was significantly lower in HCT vs. SOT (p < 0.001). Over a 7.5‐yr period, post‐transplant lymphoproliferative disorder ( PTLD ) occurred in 66 (5.8%) of 1131 patients who met adequate monitoring criteria. SOT recipients developed PTLD significantly later than HCT recipients (median, 2.8 yr vs. 121 d; p < 0.001). PTLD was documented in 53 (14%) of 376 patients who had EBV in ≥1 whole blood sample vs. 13 (2%) of 755 patients who had at least three EBV ‐negative blood samples and were never positive. PTLD risk in viremic patients increased with the peak quantity of EBV DNA emia (p < 0.001). PTLD occurred in 37/333 (11%) of patients with peak blood levels 10 3 –10 5 copies/mL vs. 16/43 (37%) of patients with levels >10 5 (p < 0.001). EBV PCR was predictive in 29 (78%) of 37 patients tested within three wk prior to tissue diagnosis of PTLD , and thus, we conclude that EBV PCR with careful attention paid to changes in EBV DNA emia could lead to earlier diagnosis and treatment of PTLD .