Surveillance of epstein-barr virus loads in adult liver transplantation: Associations with age, sex, posttransplant times, and transplant indications

Abstract

Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication after adult orthotopic liver transplantation (AOLT). Besides EBV and immunosuppression, relatively little is known about the pretransplant clinical parameters associated with the risk of PTLD, and the benefit of using EBV surveillance to predict EBV-associated disease in AOLT patients is uncertain. The aims of this single-center study were to monitor EBV viral loads (VLs) in AOLT patients and to investigate any associations with age, sex, cytomegalovirus (CMV) serostatus, posttransplant times, and indications for transplantation. 1275 blood samples that were collected from 197 AOLT patients 1 day to more than 15 years after transplantation were investigated with quantitative polymerase chain reaction for EBV and CMV DNA. Seventy-two percent of the patients had EBV DNAemia less than 100 days after transplantation without clinical manifestations. No association was observed between the EBV copy numbers and the time since transplantation. EBV DNAemia was weakly associated with male sex but was not associated with age, CMV serostatus, or indications for AOLT. The highest EBV VL levels were observed in patients who presented with congenital liver diseases, whereas patients with viral hepatitis maintained high EBV VLs after transplantation. None of the patients developed PTLD during the study period; however, 3 patients presented with EBV-associated diseases. In conclusion, EBV DNAemia is common in AOLT patients, and routine EBV surveillance has limited value for predicting EBV-associated morbidity or mortality.

Is There Diagnostic Value in Detection of Immunoglobulin G Antibodies to the Epstein–Barr Virus Early Antigen?

“…Two of these patients were women, aged 60 and 56 years, with neurological symptoms, and EBV was detected in their cerebrospinal fluid. 19 After extensive clinical, radiological, and microbiological analysis, the diagnosis of EBV encephalitis was made because there was no evidence of lymphoproliferation. The third patient was a 55-year-old man that developed a febrile illness, had elevated liver function tests, and high EBV viral loads of 3,807,000 copies/mL.…”

“…All patients were managed with the reduction of immunosuppression and administration of antiviral therapy. 19 Ethical approval for the study was obtained from the Research Ethics Committee of St. Vincent's University Hospital and the Human Research Ethics Committee of University College Dublin.…”

Post-Transplant Lymphoproliferative Disease (PTLD): Risk Factors, Diagnosis, and Current Treatment Strategies

“…Data evaluating the predictive value of host serum EBV and risk of PTLD have shown mixed results [27, 28]. The American Society of Transplantation recommends checking monthly EBV viral load for 1 year in EBV(−) patients following SOT [28].…”

Molecular Pathogenesis of B-Cell Posttransplant Lymphoproliferative Disorder: What Do We Know So Far?

“…This population mainly comprises children [10]. Analogously, patients undergoing myeloablative hematopoietic stem cell transplantation (HSCT) or individuals with a chronically high EBV viral load following transplantation are prone to early-onset PTLD [11], although the latter is still debated [12]. Regarding HSCT, PTLD development also greatly varies according to the procedure and ranges from 0.5% (for HLA -matched noncomplicated transplants) to 25% (for T-cell-depleted highly immunosuppressed transplants that lack T-cell-mediated anti-EBV immune responses) [13].…”