Epstein-Barr virus transmission from a blood donor to an organ transplant recipient with recovery of the same virus strain from the recipient's blood and oropharynx

Abstract

A previous study (Savoie et al, Blood 83:2715, 1994) identified eight transplant patients who acquired Epstein-Barr virus (EBV) infection during the peritransplant period. Three of these patients subsequently developed B-cell lymphoproliferative disease within 4 months of transplantation. Among these, there was a 16-year-old liver transplant patient who was negative for EBV at the time of transplant and who received an EBV-negative organ. After transplant, this patient was transfused with 9 U of packed red blood cells. Eight of the donors were EBV-positive and one was EBV-negative. We succeeded in obtaining spontaneous lymphoblastoid cell lines (LCLs) from the blood of three of these donors, one of whom also yielded a cord-blood line established with his throat-wash EBV. Blood from a fourth donor did not yield an LCL, but his throat washing did have transforming activity when inoculated onto cord-blood leukocytes. We initially could establish spontaneous LCLs only from the recipient's blood. However, a throat- wash sample taken 11 weeks later did show transforming activity. The recipient was shown to have acquired the EBV infection from one of eight EBV-seropositive blood donors. Analysis of fragment length polymorphisms after polymerase chain reaction amplification of the EBV BamHI-K fragment was used to establish strain identity. Western blot analysis for existence of size polymorphisms in three classes of Epstein-Barr nuclear antigens (EBNA-1, EBNA-2, and EBNA-3) confirmed the DNA results. It is noteworthy that the blood donor responsible for transmitting his EBV strain to the recipient had experienced clinical infectious mononucleosis 15 months before donating blood. Our results may, thus, indicate a requirement for leukodepletion of blood destined for immunosuppressed EBV-negative patients. Finally, blood donors with a recent history of infectious mononucleosis should probably be identified so that their blood is not given to EBV-negative transplant patients.

Quantitation of human herpesvirus 8 (HHV‐8) antibody in patients transfused with HHV‐8–seropositive blood

“…In a recent study, transfusion of HHV‐8 antibody–positive blood in Uganda was associated with subsequent seroconversion in recipients, indicating that HHV‐8 was transmitted by transfusion in an area where HHV‐8 and Kaposi's sarcoma are endemic 2 . HHV‐8, then, is the third herpesvirus, after cytomegalovirus (CMV) and Epstein‐Barr virus, to be identified as transmissible by blood transfusion, 3,4 although with apparent differences in levels of infectivity. For example, cumulative experience with CMV suggests that 13% to 37% of CMV‐seronegative immunocompromised patients may contract CMV infections from blood transfusions that are not CMV screened and not leukoreduced in donor populations with a 40% to 60% CMV seroprevalence 4,5 .…”

Efficacy of Epstein‐Barr virus removal by leukoreduction of red blood cells

“…[5][6][7] Transfusion-transmitted EBV from cellular blood components has been infrequently reported. [8][9][10][11][12][13] Leukoreduction with third-generation filters depletes greater than 3 logs (99.9%) of white cells (WBCs) from blood components. This process has been shown to reduce the number of cytomegalovirus (CMV) genomes and its infectivity in cellular blood component.…”

Transcription of latent and replicative Epstein‐Barr‐virus genes in bone‐marrow and peripheral‐blood mononuclear cells of healthy donors

“…BZLF-1 transcription would be suggestive of active viral replication in EBV-infected human B lymphocytes. Consistent with this scenario are observations by Anagnostopoulos et al (1995), Alfieri et al (1996), Tao et al (1995) and Decker et al (1996). Heterogeneous expression of EBV latent proteins has been described in unique EBV-harbouring human B-cell lines (Taylor et al, 1994), as well as in tissues of several EBV-associated malignancies (Niedobitek et al, 1995;Oudejans et al, 1995a,b;Pathmanathan et al, 1995).…”