Details

Autor(en) / Beteiligte

• Rampersad, Christie
• Wiebe, Chris
• Balshaw, Robert
• Bullard, Jared
• Cortes Villalobos, Armelle Perez
• Trachtenberg, Aaron
• Shaw, James
• Karpinski, Martin
• Goldberg, Aviva
• Birk, Patricia
• Pinsk, Maury
• Rush, David N.
• Nickerson, Peter W.
• Ho, Julie

Titel

Epidemiology of Epstein-Barr Virus Chronic High Viral Load in Kidney Transplant Recipients

Ist Teil von

• Transplantation direct, 2024-03, Vol.10 (3), p.e1579

Ort / Verlag

Wolters Kluwer

Erscheinungsjahr

2024

Quelle

EZB Free E-Journals

Beschreibungen/Notizen

• Background. Epstein-Barr virus (EBV) chronic high viral load (CHVL) may be defined by >16 000 copies/mL whole blood or >200 copies/10 5 peripheral blood mononuclear cells in >50% samples exceeding 6 mo. EBV CHVL has only been characterized in a few small pediatric studies, with heterogeneous results and unclear clinical significance. Methods. This single-center observational study evaluated adult and pediatric kidney transplant recipients transplanted between 2010 and 2021 on tacrolimus/mycophenolate-based/prednisone immunosuppression. The primary outcome was EBV CHVL prevalence. Secondary outcomes included recipient characteristics, DNAemia kinetics, and posttransplant lymphoproliferative disorder (PTLD) in recipients with EBV CHVL versus low-grade DNAemia or no DNAemia. Results. Five hundred forty-one recipients had a mean follow-up of 4.6 y. Fourteen recipients (2.6%) developed EBV CHVL, 70 (12.9%) had low-grade EBV DNAemia, and 457 (84.5%) had no EBV DNAemia. EBV CHVL was more common in recipients who were Caucasian ( P = 0.04), younger ( P = 0.04), received induction immunosuppression ( P = 0.02), and had high-risk donor–recipient EBV serologic mismatch ( P < 0.0001). CHVL patients had a higher first viral load ( P = 0.03), longer time to maximum viral load ( P = 0.02), and did not achieve sustained DNAemia clearance versus low-grade DNAemia. Three EBV-positive PTLD cases occurred in recipients with a history of EBV DNAemia. PTLD was present in 7.1% (1/14) CHVL versus 2.9% (2/70) low-grade DNAemia patients ( P = 0.002). EBV DNAemia developed in 32 EBV seronegative recipients (32/59; 54%); clearance was achieved in 70% (14/20) with low-grade DNAemia but no CHVL (0/12; P = 0.0001). Conclusions. CHVL was uncommon and appeared to occur after primary EBV infection. Future studies should explore other potentially modifiable risk factors for PTLD, including optimal management of EBV DNAemia.