Lymphoproliferative disorders in heart transplant recipients: role of hepatitis C virus (HCV) and Epstein-Barr virus (EBV) infection

Abstract

Post-transplant lymphoproliferative disorders (PTLD) are a well known complication after orthotopic heart transplantation (OHT). Although Epstein-Barr virus (EBV) infection has long been implicated in the pathogenesis of such disorders, other factors may play a part. Because of its lymphotropic properties, hepatitis C virus (HCV) may induce clonal expansion of B-lymphocytes and lead to PTLD. The aim of this study was to evaluate the potential association between HCV and EBV infection and PTLD in OHT patients. The retrospective study considered 404 adult patients screened for HCV. EBV serology, histology, and molecular analysis on tissue biopsies were performed in the PTLD patients (10/404, 2.5%). HCV positivity was found in 36/404 (8.9%) patients. The EBV genome was expressed on all neoplastic tissue samples analyzed. A higher proportion of HCV-positive patients developed PTLD than the HCV-negative cases (8% vs 2%, P = 0.017). EBV has a demonstrated role in the onset of PTLD, but HCV infection probably has to be considered as well.

De novo malignancies after liver transplantation: A major cause of late death

“…42 The actuarial 1-year incidence of PTLD is approximately 2%, although the incidence is up to 10 times greater in children aged younger than 5 years (more likely to be EBV seronegative) compared with adults (usually EBV seropositive). 43,44 Of note to this discussion are recent reports of an increased incidence of PTLD in patients with hepatitis C virus coinfection, not only in liver transplant recipients, but in heart transplant recipients, as well 45,46 The pathophysiological course of PTLD is not completely understood. 41 The majority of PTLDs are of B cell origin (Ͼ90%), whereas the remainder is of T cell origin, and only rarely of null cell, i.e., without identifiable T-or B-cell markers.…”

Post-Transplant Lymphoproliferative Disorders Occurring After Renal Transplantation in Adults: Report of 230 Cases From the French Registry

“…EBV seronegativity (7), chronic antigenic stimulation, the degree of immunosuppression (4,8,9) and viral co-infections like hepatitis C virus (HCV) and cytomegalovirus (10)(11)(12) are the most frequent.…”

Plasmablastic Lymphoma Following Transplantation

“…In patients who have received a transplant, the risk of lymphoma is increased 20% to 120% compared with the general population (6). Additionally, several risk factors have been shown to increase the risk of PTLD, including immunosuppression (6-8), EBV (9-12), genetic susceptibility (13), and a host of other miscellaneous factors including Caucasian race (14), hepatitis C, cytomegalovirus, and human herpes virus-8 infection (15)(16)(17). PTLD is classifi ed into four categories based on immunophenotype, morphology, and molecular criteria.…”