Evaluation of Epstein-Barr Virus (EBV) Antibody Screening of Organ Donors for Allocation of Organs to EBV Serostatus Matched Recipients

• Published in: Transplantation proceedings Vol. 38; no. 10; pp. 3404 - 3405
• Main Author: Lazda, V.A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2006; Elsevier Science
• Subjects: Adult; Antibodies, Viral - blood; Antigens, Viral - immunology; Biological and medical sciences; Cadaver; Capsid - immunology; Enzyme-Linked Immunosorbent Assay; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Herpesvirus 4, Human - immunology; Humans; Immunoglobulin G - blood; Lymphoproliferative Disorders - prevention & control; Lymphoproliferative Disorders - virology; Mass Screening - methods; Medical sciences; Patient Selection; Postoperative Complications - prevention & control; Postoperative Complications - virology; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Donors; Tissue, organ and graft immunology; Gammaherpesvirinae; Human; Evaluation; Antibody; Herpesviridae; Recipient; Transplantation; Epstein Barr virus; Medical screening; Attribution; Infection; Virus; Medicine; Organ donation; Treatment; Allocation; Donor; Surgery; Viral disease; Graft; Organ
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2006.10.066

Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication following organ transplantation. The greatest risk is seen in Epstein-Barr virus (EBV)-seronegative patients receiving allografts from EBV-seropositive donors. The severity and frequency of PTLD are particular concerns for pediatric patients, who frequently are EBV negative and hence more likely to be EBV infected from an EBV-positive organ donor. The aim of this study was to analyze the EBV serostatus of deceased organ donors and to assess the likelihood of recipient/donor matching for EBV serostatus. Sera obtained from local deceased organ donors for the period 2004–2005 were retrospectively tested for EBV viral capsid antigen (VCA) IgG and IgM antibodies by an enzyme-linked immunosorbent assay (ELISA). The analysis included only data from those donors who were tested using a pretransfusion specimen (n = 459). The influence of various factors on the EBV serostatus of the donor was assessed, including age, gender, ethnicity, and cytomegalovirus (CMV) serostatus of the donor. Overall, only 27 (6%) of the 459 donors were EBV seronegative, with 94% being positive for IgG antibodies to EBV. A higher percentage of the EBV-seronegative donors were younger donors (age ≤35 years), compared with EBV-seropositive donors, 74% (n = 27) vs 31% (n = 432), P < .0001. A higher percentage (85%) of the younger (age ≤35 years) EBV-seronegative donors (n = 20) were also CMV seronegative. There was also a greater likelihood for the younger (age ≤35 years) CMV-seronegative donors to be EBV seronegative, compared with the older (age >35 years) CMV-seronegative donors, 20% (n = 83) vs 1% (n = 93), P < .0001. There was no influence of other factors examined on EBV serostatus. EBV-seronegative organ donors are infrequent and therefore provide only a limited supply of organs for patients in need of them. The higher frequency of EBV-seronegative donors being the younger donors will benefit the pediatric patients who have the greatest need for an EBV serostatus matched organ from a younger donor. Recent policy changes at the United Network for Organ Sharing (UNOS) giving priority to pediatric patients for kidneys from younger donors (age ≤35 years) and prospective EBV testing of donors will be helpful in the appropriate allocation of these organs.