Quantitative Epstein–Barr virus shedding and its correlation with the risk of post-transplant lymphoproliferative disorder

Carol J Holman; Amy B Karger; Beth D Mullan; Richard C Brundage; Henry H Balfour

doi:10.1111/j.1399-0012.2012.01608.x

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Quantitative Epstein–Barr virus shedding and its correlation with the risk of post-transplant lymphoproliferative disorder

Journal article

Peer reviewed

Quantitative Epstein–Barr virus shedding and its correlation with the risk of post-transplant lymphoproliferative disorder

Carol J Holman, Amy B Karger, Beth D Mullan, Richard C Brundage and Henry H Balfour

Clinical transplantation, Vol.26(5), pp.741-747

2012

DOI: 10.1111/j.1399-0012.2012.01608.x

PMCID: PMC3718003

PMID: 22385033

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Abstract

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 10 3 –10 5 copies/mL vs. 16/43 (37%) of patients with levels >10 5 (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.

Epstein–Barr virus DNAemia

primary Epstein–Barr virus infection

post-transplant lymphoproliferative disorder

hematopoietic cell transplantation

solid organ transplantation

Epstein–Barr virus

quantitative Epstein–Barr virus PCR

Details

Title: Subtitle: Quantitative Epstein–Barr virus shedding and its correlation with the risk of post-transplant lymphoproliferative disorder
Creators: Carol J Holman - Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA
Amy B Karger - Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA
Beth D Mullan - Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA
Richard C Brundage - Department of Clinical and Experimental Pharmacology, University of Minnesota Medical Center, Minneapolis, MN, USA
Henry H Balfour - Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA
Resource Type: Journal article
Publication Details: Clinical transplantation, Vol.26(5), pp.741-747
DOI: 10.1111/j.1399-0012.2012.01608.x
PMID: 22385033
PMCID: PMC3718003
NLM abbreviation: Clin Transplant
ISSN: 0902-0063
eISSN: 1399-0012
Grant note: P01 DK013083 || DK / National Institute of Diabetes and Digestive and Kidney Diseases : NIDDK
Language: English
Date published: 2012
Academic Unit: Pathology
Record Identifier: 9984047619602771

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