Clinical Utility of Epstein-Barr Virus Viral Load Monitoring and Risk Factors for Posttransplant Lymphoproliferative Disorders After Kidney Transplantation: A Single-Center, 10-Year Observational Cohort Study

Erica Franceschini, MD; Jessica Plessi, MD; Stefano Zona, MD; Antonella Santoro, MD; Margherita Digaetano, MD; Francesco Fontana, MD; Gaetano Alfano, MD; Giovanni Guaraldi, MD; Patrizia Comoli, MD; Francesca Facchini, MD; Leonardo Potenza, MD, PhD; William Gennari, MD; Mauro Codeluppi, MD; Mario Luppi, MD, PhD; Gianni Cappelli, MD; Inge C. Gyssens, MD, PhD; Cristina Mussini, MD

doi:10.1097/TXD.0000000000000703

Transplantation Direct (Jul 2017)

Clinical Utility of Epstein-Barr Virus Viral Load Monitoring and Risk Factors for Posttransplant Lymphoproliferative Disorders After Kidney Transplantation: A Single-Center, 10-Year Observational Cohort Study

Erica Franceschini, MD,
Jessica Plessi, MD,
Stefano Zona, MD,
Antonella Santoro, MD,
Margherita Digaetano, MD,
Francesco Fontana, MD,
Gaetano Alfano, MD,
Giovanni Guaraldi, MD,
Patrizia Comoli, MD,
Francesca Facchini, MD,
Leonardo Potenza, MD, PhD,
William Gennari, MD,
Mauro Codeluppi, MD,
Mario Luppi, MD, PhD,
Gianni Cappelli, MD,
Inge C. Gyssens, MD, PhD,
Cristina Mussini, MD

Affiliations

Erica Franceschini, MD: 1 Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Jessica Plessi, MD: 1 Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Stefano Zona, MD: 1 Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Antonella Santoro, MD: 1 Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Margherita Digaetano, MD: 1 Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Francesco Fontana, MD: 2 Clinic of Nephrology, University of Modena and Reggio Emilia, Modena, Italy.
Gaetano Alfano, MD: 2 Clinic of Nephrology, University of Modena and Reggio Emilia, Modena, Italy.
Giovanni Guaraldi, MD: 3 Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy.
Patrizia Comoli, MD: 4 Pediatric Hematology-Oncology, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy.
Francesca Facchini, MD: 2 Clinic of Nephrology, University of Modena and Reggio Emilia, Modena, Italy.
Leonardo Potenza, MD, PhD: 5 Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Modena, Italy.
William Gennari, MD: 6 Microbiology Laboratory, Azienda Ospedaliero-Universitaria Policlinico Modena, Italy.
Mauro Codeluppi, MD: 1 Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Mario Luppi, MD, PhD: 5 Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Modena, Italy.
Gianni Cappelli, MD: 2 Clinic of Nephrology, University of Modena and Reggio Emilia, Modena, Italy.
Inge C. Gyssens, MD, PhD: 7 Radboud University Medical Centre Nijmegen, The Netherlands.
Cristina Mussini, MD: 3 Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy.

DOI: https://doi.org/10.1097/TXD.0000000000000703
Journal volume & issue: Vol. 3, no. 7
p. e182

Abstract

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Background. Posttransplant lymphoproliferative disease (PTLD) is an important cause of morbidity and mortality in solid organ transplants. Epstein Barr virus (EBV) plays a major role in PTLD development. Guidelines recommend EBV viral load (VL) monitoring in high-risk populations in the first year. Methods. Retrospective observational study in all adult patients who had at least 1 EBV-VL performed in the postkidney transplant (KT) period from January 2005 to December 2014 at the Policlinico Modena Hospital. We compared patients with negative EBV-DNA to patients with positive EBV-DNA and we described PTLD developed in the study period. Results. One hundred ninety (36.3%) KT patients of 523 were screened for EBV-DNA with 796 samples. One hundred twenty-eight (67.4%) of 190 tested patients presented at least 1 positive sample for EBV. Older age, the use of sirolimus, everolimus, and steroids were associated with EBV-DNA positivity in the univariate analysis. Nine (1.7%) of 523 patients had PTLD. Incidence rate of PTLD in the KT cohort was 0.19/100 person year follow-up (95% confidence interval, 0.09-0.37). One of 9 patients developed early PTLD and was a high-risk patient. Only this PTLD case was positive for EBV. No PTLD case had an EBV-VL superior to 4000 copies/mL. Conclusions. Our results suggest that the keystone of PTLD diagnosis is the clinical suspicion. Our study suggests that, in line with guidelines, EBV-VL assays may be avoided in low-risk patients in the absence of a strong clinical PTLD suspicion without increasing patients' risk of developing PTLD. This represents a safe and cost-saving clinical strategy for our center.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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