Conflict of interest: None.
Quantitative Epstein–Barr virus shedding and its correlation with the risk of post-transplant lymphoproliferative disorder
Article first published online: 4 MAR 2012
© 2012 John Wiley & Sons A/S.
Volume 26, Issue 5, pages 741–747, September/October 2012
How to Cite
Holman CJ, Karger AB, Mullan BD, Brundage RC and Balfour HH Jr. Quantitative Epstein–Barr virus shedding and its correlation with the risk of post-transplant lymphoproliferative disorder. Clin Transplant 2012 DOI: 10.1111/j.1399-0012.2012.01608.x. © 2012 John Wiley & Sons A/S.
- Issue published online: 14 OCT 2012
- Article first published online: 4 MAR 2012
- Manuscript Accepted: 29 DEC 2011
- NIH. Grant Number: 2PO1 DK 13083
- University of Minnesota International Center for Antiviral Research and Epidemiology
- Minnesota Medical Foundation
- Epstein–Barr virus DNAemia;
- Epstein–Barr virus;
- hematopoietic cell transplantation;
- post-transplant lymphoproliferative disorder;
- primary Epstein–Barr virus infection;
- quantitative Epstein–Barr virus PCR;
- solid organ transplantation
We postulated that quantitative monitoring of Epstein–Barr virus (EBV) shedding after transplantation could distinguish EBV-associated illnesses and predict clinical outcome. EBV DNA was measured in solid organ (SOT) and hematopoietic cell transplants (HCT) using our own real-time TaqMan EBV PCR. The proportion of patients who had EBV DNAemia post-transplant was significantly lower in HCT vs. SOT (p < 0.001). Over a 7.5-yr period, post-transplant lymphoproliferative disorder (PTLD) occurred in 66 (5.8%) of 1131 patients who met adequate monitoring criteria. SOT recipients developed PTLD significantly later than HCT recipients (median, 2.8 yr vs. 121 d; p < 0.001). PTLD was documented in 53 (14%) of 376 patients who had EBV in ≥1 whole blood sample vs. 13 (2%) of 755 patients who had at least three EBV-negative blood samples and were never positive. PTLD risk in viremic patients increased with the peak quantity of EBV DNAemia (p < 0.001). PTLD occurred in 37/333 (11%) of patients with peak blood levels 103–105 copies/mL vs. 16/43 (37%) of patients with levels >105 (p < 0.001). EBV PCR was predictive in 29 (78%) of 37 patients tested within three wk prior to tissue diagnosis of PTLD, and thus, we conclude that EBV PCR with careful attention paid to changes in EBV DNAemia could lead to earlier diagnosis and treatment of PTLD.