Kidney transplantation using donor organs carrying the Epstein-Barr virus may increase the risk of posttransplant lymphoproliferative disorder among recipients who have never been exposed to the virus, according to a recent study published by Potluri et al in the Annals of Internal Medicine.
Background
Over 90% of U.S. adults are or have been infected with the Epstein-Barr virus, a highly infectious agent of the herpesvirus family known for causing infectious mononucleosis and for its association with several cancers and autoimmune diseases.
Posttransplant lymphoproliferative disorder is a potentially life-threatening posttransplant complication in which the body’s immune cells can grow controllably and act like cancer.
Study Methods and Results
Researchers estimated that 4% to 5% of adult kidney transplant recipients—up to 1,200 patients per year—could be at risk of developing posttransplant lymphoproliferative disorder. Among kidney transplant recipients who had not previously been infected with the Epstein-Barr virus, 22% of those who received a kidney from a donor who previously was infected with the virus developed posttransplant lymphoproliferative disorder within 3 years of their kidney transplant. The rate was 5 to 10 times higher than previously recognized by national registry data.
Additionally, kidney transplant recipients who did not have the Epstein-Barr virus and received kidneys from donors who did have a prior exposure to the virus faced a higher risk of mortality. For instance, nearly 33% of those affected by posttransplant lymphoproliferative disorder died from the condition during the study period.
“National registry data likely underestimates [posttransplant lymphoproliferative disorder] incidence [as a result of] incomplete reporting and errors in tracking whether organ donors and recipients have been exposed to viruses like [the Epstein-Barr virus],” emphasized lead study author Vishnu Potluri, MD, MPH, Assistant Professor in the Division of Renal Electrolyte and Hypertension at the University of Pennsylvania. “Our research used comprehensive, high-quality data from two leading U.S. transplant centers, and revealed a much higher risk than previous data has suggested.”
The research may add to the overall understanding of posttransplant lymphoproliferative disorder. Although the risk of being diagnosed with the condition following a kidney transplant is widely recognized, it has historically been studied in populations of pediatric patients, since the likelihood of adults having no exposure to the Epstein-Barr virus is often far lower.
Conclusions
“We need to rethink how we monitor patients for [Epstein-Barr virus] infections and how we manage immunosuppression for these high-risk patients. This includes early and routine testing for [Epstein-Barr virus] activity in the blood and exploring personalized adjustments to immunosuppressive therapy,” suggested co–study author Emily Blumberg, MD, Director of Transplant Infectious Diseases at the University of Pennsylvania.
“Given the significant threat to survival posed by [posttransplant lymphoproliferative disorder] and the substantial discrepancy between our findings and prior data, our study serves as a call to action to prioritize further research to enhance the safety and survival of this vulnerable transplant population,” concluded senior study author Chethan Puttarajappa, MD, MBBS, MS, Associate Professor in the Renal Electrolyte Division at the University of Pittsburgh.
Disclosure: The research in this study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Allergy and Infectious Diseases, and the University of Pennsylvania McCabe Fund. For full disclosures of the study authors, visit acpjournals.org.
