Adults who receive Epstein–Barr donor kidneys face risk of post-transplant complications
Key takeaways:
- All-cause graft failure risk was higher for recipients of Epstein–Barr virus D-positive/R-negative kidneys.
- The Epstein–Barr virus D-positive/R-negative group had up to a 10-fold higher cumulative incidence of post-transplant lymphoproliferative disorder.
Patients who receive kidney transplants from Epstein–Barr virus D-positive/R-negative donors face a higher risk for post-transplant lymphoproliferative disorder, data show.
“Post-transplant lymphoproliferative [PTLDs] disorders are associated with high morbidity and mortality,” Vishnu S. Potluri, MD, MPH, assistant professor of medicine at the Hospital of the University of Pennsylvania, wrote with colleagues. “Most [Epstein–Barr virus] EBV-associated PTLDs occur after donor-to-recipient EBV transmission at the time of transplantation. … Limited information about the timing and magnitude of posttransplant EBV DNAemia and its relationship to PTLD has hindered the development of evidence-based strategies to mitigate these complications.”
Researchers conducted a retrospective cohort study with 104 EBVD-positive/R-negative kidney transplant recipients matched to 312 EBV R-negative recipients.
Adults who had a transplant between 2010 and 2022 were recruited from the Hospital of the University of Pennsylvania in Philadelphia and the University of Pittsburgh Medical Center in Pittsburgh as part of the study. Mean patient age was 42 years, 59% had living donor transplants and 95% had thymoglobulin induction.
The study aimed to determine whether a mismatch in the EBV status of the donor and recipient impacts PTLD outcomes, as well as graft and patient survival among adults with a kidney transplant.
In the EBV D-positive/R-negative transplant group, 48.1% developed EBV DNAemia, according to the findings, with a median onset of 198 days post-transplantation. In addition, 22.1% of patients in this group were diagnosed with PTLD at a median 202 days after transplantation.
The risk for all-cause graft failure was also higher for EBV D-positive/R-negative transplant recipients (HR = 2.21; 95% CI, 1.06-4.63) compared with patients with tranplants without EBV.
Overall, EBV D-positive/R-negative transplant recipients had a fivefold to 10-fold higher cumulative incidence of with PTLD vs. controls.
“Our study highlights the need to urgently standardize care and develop additional tools to reduce the risk for PTLD for [EBV D-positive/R-negative] recipients,” Potluri and colleagues wrote. “Post-transplant cancer is a leading concern of patients, clinicians and caregivers involved in kidney transplantation. During pretransplant care, the risks and benefits of waiting for an EBV-seronegative donor kidney should be explored and discussed with transplant candidates.”
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Potluri V, et al. Ann Intern Med. 2024;doi.org/10.7326/ANNALS-24-00165.
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