The Association of Epstein–Barr Virus Donor and Recipient Serostatus With Outcomes After Kidney Transplantation: A Retrospective Cohort Study - Annals
of Internal Medicine
28 January 2025
https://doi.org/10.7326/ANNALS-24-00165
Authors:
Vishnu S. Potluri, MD, MPH,
Siqi Zhang, MS,
Douglas E. Schaubel, PhD ,
Salma Shaikhouni, MD,
Emily A.Blumberg, MD,
Sunita D. Nasta, MD,
Roy D. Bloom, MD, … SHOW ALL …, and
Chethan M. Puttarajappa, MD, MS
Abstract
Background:
Prior studies indicate that 1% to 4% of Epstein–Barr virus (EBV)–seronegative recipients of EBV-seropositive donor (EBV D+/R−) kidneys develop posttransplant lymphoproliferative disorder (PTLD). However, these estimates are based on limited data that lack granularity.
Objective:
To determine the associations between pretransplant EBV D+/R− and recipient EBV-seropositive status (R+) and the outcomes of PTLD and graft and patient survival among adult kidney transplant recipients.
Design:
Retrospective cohort study.
Setting:
Two large U.S. transplant centers.
Participants:
Epstein–Barr virus D+/R− and EBV R+ recipients matched 1:3 on donor, recipient, and transplant characteristics between 1 January 2010 and 30 June 2022.
Measurements:
Exposure was pretransplant donor and recipient EBV serostatus. The primary outcome was biopsy-proven PTLD. Secondary outcomes were all-cause graft loss (death, retransplant, or graft failure) and death. Follow-up was truncated to 3 years after transplant.
Results:
The final cohort comprised 104 EBV D+/R− recipients matched to 312 EBV R+ recipients. The mean age was 42 years (SD, 17.1), 59% were living donor transplants, and 95% received thymoglobulin induction. Among EBV D+/R− recipients, 50 (48.1%) developed EBV DNAemia, with a median time of 198 days (IQR, 110 to 282 days) after transplantation. Posttransplant lymphoproliferative disorder occurred in 23 (22.1%) EBV D+/R− recipients at a median of 202 days (IQR, 118 to 317 days) after transplantation. Epstein–Barr virus D+/R− recipients had higher all-cause graft failure (hazard ratio, 2.21 [95% CI, 1.06 to 4.63]); mortality was higher but not statistically significant (hazard ratio, 2.19 [CI, 0.94 to 5.13]).
Limitation:
Two-center study
Conclusion:
Compared with previous studies, this study showed that EBV D+/R− kidney recipients face a 5- to 10-fold higher cumulative incidence of PTLD. Strategies to mitigate the PTLD risk are urgently needed.
https://www.acpjournals.org/doi/10....ori:rid:crossref.org&rfr_dat=cr_pub++0pubmed&
