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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
Author(s) -
Schachtner Thomas,
Reinke Petra
Publication year - 2016
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12605
Subject(s) - medicine , rituximab , viremia , seroconversion , immunology , transplantation , epstein–barr virus , virus , virology , antibody
Background Because of the strikingly increased risk of post‐transplant lymphoproliferative disorder ( PTLD ) in Epstein‐Barr virus ( EBV )‐seronegative kidney transplant recipients ( KTR s) from EBV ‐seropositive donors— EBV (D + R − ), special strategies need to be defined to prevent EBV transmission and EBV viremia. Methods We studied all KTR s at our center between 2008 and 2012. Seventeen of 402 KTR s (4.2%) were identified as EBV (D + R − ), among which 5 KTR s received kidneys from living donors and 12 KTR s from deceased donors. KTR s 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 KTR s from deceased donors, all 12 KTR s (100%) showed EBV seroconversion, 7 KTR s (58%) showed active EBV viremia, and 1 KTR (8%) developed PTLD . In comparison, 3 of 5 KTR s from living donors, who received pretransplant rituximab, remained EBV ‐seronegative post transplantation, and no KTR developed EBV viremia ( P <.05). All KTR s 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 KTR s.