Impact of Epstein―Barr virus donor and recipient serostatus on the incidence of post-transplant lymphoproliferative disorder in kidney transplant recipients

• Published in: Nephrology, dialysis, transplantation Vol. 27; no. 7; pp. 2971 - 2979
• Main Authors: SANTOS SAMPAIO, Marcelo, CHO, Yong W, SHAH, Tariq, BUNNAPRADIST, Suphamai, HUTCHINSON, Ian V
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.07.2012
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Emergency and intensive care: renal failure. Dialysis management; Epstein-Barr Virus Infections - blood; Epstein-Barr Virus Infections - virology; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection - drug therapy; Graft Rejection - etiology; Graft Survival; Herpesvirus 4, Human; Humans; Incidence; Intensive care medicine; Kidney Transplantation - adverse effects; Los Angeles - epidemiology; Lymphoproliferative Disorders - blood; Lymphoproliferative Disorders - epidemiology; Lymphoproliferative Disorders - etiology; Male; Medical sciences; Middle Aged; Postoperative Complications; Prognosis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - surgery; Secondary Prevention; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate; Tissue Donors; Young Adult; Los Angeles; Gammaherpesvirinae; Kidney disease; Suboptimal donor; Urinary system disease; Prognosis; post-transplant lymphoproliferative disorder; Hemodialysis; Herpesviridae; renal transplantation; Hemopathy; Recipient; Epstein Barr virus; Epstein―Barr virus; Homotransplantation; transplant outcomes; OPTN/UNOS; Incidence; Virus; Extrarenal dialysis; Lymphoproliferative syndrome; Renal failure
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfr769

Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of transplantation. Using the OPTN/UNOS database, primary kidney recipients (2000-2009) were stratified according to transplant type (deceased donor, DD or living donor, LD), donor (D) and recipient (R) Epstein-Barr virus (EBV) serostatus (R+; D+/R- and D-/R-) and recipient age. Incidence and adjusted risk of PTLD and death were compared. Of the 137 939 primary kidney recipients transplanted between 2000 and 2009, 913 subsequently developed PTLD. In 90 208 recipients with known EBV serostatus, we found a trend toward a decrease in PTLD incidence in years 2007-2009 when compared to 2000-2003. This was due to a significant decrease in PTLD incidence in EBV- recipients. Of those, 61 273 had a known donor serostatus and were further examined. In adults, PTLD incidence (in 1000 person-years) in DD and LD was 7.0 and 7.0 in D+/R-; 3.0 and 2.5 in D-/R- and 1.2 and 1.0 in R+, respectively. The hazard ratio (HR) for PTLD (R+ as reference) in D+/R- (6.2 in DD and 7.2 in LD) was double to thrice than for D-/R- transplants (2.4 in both DD and LD). In pediatric recipients, PTLD incidence in DD and LD was 15.9 and 17.3 in D+/R-; 12 and 18 in D-/R- and 1.2 and 2.2 in R+, respectively. The HR for PTLD was 17.4 and 6.9 in D+/R- and 15.9 and 7.6 in D-/R- in DD and LD, respectively. A D+/R-, compared with a D-/R- transplant, may contribute to an increase in PTLD incidence of 35 and 42% in adult DD and LD transplants, respectively.