Epidemiology of Epstein-Barr Virus Chronic High Viral Load in Kidney Transplant Recipients

Christie Rampersad, MD; Chris Wiebe, MD; Robert Balshaw, PhD; Jared Bullard, MD; Armelle Perez Cortes Villalobos, MD; Aaron Trachtenberg, MD, PhD; James Shaw, MD, PhD; Martin Karpinski, MD; Aviva Goldberg, MD; Patricia Birk, MD; Maury Pinsk, MD; David N. Rush, MD; Peter W. Nickerson, MD; Julie Ho, MD

doi:10.1097/TXD.0000000000001579

Transplantation Direct (Mar 2024)

Epidemiology of Epstein-Barr Virus Chronic High Viral Load in Kidney Transplant Recipients

Christie Rampersad, MD,
Chris Wiebe, MD,
Robert Balshaw, PhD,
Jared Bullard, MD,
Armelle Perez Cortes Villalobos, MD,
Aaron Trachtenberg, MD, PhD,
James Shaw, MD, PhD,
Martin Karpinski, MD,
Aviva Goldberg, MD,
Patricia Birk, MD,
Maury Pinsk, MD,
David N. Rush, MD,
Peter W. Nickerson, MD,
Julie Ho, MD

Affiliations

Christie Rampersad, MD: 1 Transplant Nephrology and Ajmera Transplant Center, University Health Network, University of Toronto, Toronto, ON, Canada.
Chris Wiebe, MD: 3 Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
Robert Balshaw, PhD: 5 George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
Jared Bullard, MD: 6 Cadham Provincial Laboratory, Shared Health Manitoba, Winnipeg, MB, Canada.
Armelle Perez Cortes Villalobos, MD: 3 Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
Aaron Trachtenberg, MD, PhD: 3 Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
James Shaw, MD, PhD: 3 Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
Martin Karpinski, MD: 3 Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
Aviva Goldberg, MD: 7 Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
Patricia Birk, MD: 7 Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
Maury Pinsk, MD: 7 Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
David N. Rush, MD: 3 Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
Peter W. Nickerson, MD: 3 Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
Julie Ho, MD: 3 Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.

DOI: https://doi.org/10.1097/TXD.0000000000001579
Journal volume & issue: Vol. 10, no. 3
p. e1579

Abstract

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Background. Epstein-Barr virus (EBV) chronic high viral load (CHVL) may be defined by >16 000 copies/mL whole blood or >200 copies/105 peripheral blood mononuclear cells in >50% samples exceeding 6 mo. EBV CHVL has only been characterized in a few small pediatric studies, with heterogeneous results and unclear clinical significance. Methods. This single-center observational study evaluated adult and pediatric kidney transplant recipients transplanted between 2010 and 2021 on tacrolimus/mycophenolate-based/prednisone immunosuppression. The primary outcome was EBV CHVL prevalence. Secondary outcomes included recipient characteristics, DNAemia kinetics, and posttransplant lymphoproliferative disorder (PTLD) in recipients with EBV CHVL versus low-grade DNAemia or no DNAemia. Results. Five hundred forty-one recipients had a mean follow-up of 4.6 y. Fourteen recipients (2.6%) developed EBV CHVL, 70 (12.9%) had low-grade EBV DNAemia, and 457 (84.5%) had no EBV DNAemia. EBV CHVL was more common in recipients who were Caucasian (P = 0.04), younger (P = 0.04), received induction immunosuppression (P = 0.02), and had high-risk donor–recipient EBV serologic mismatch (P < 0.0001). CHVL patients had a higher first viral load (P = 0.03), longer time to maximum viral load (P = 0.02), and did not achieve sustained DNAemia clearance versus low-grade DNAemia. Three EBV-positive PTLD cases occurred in recipients with a history of EBV DNAemia. PTLD was present in 7.1% (1/14) CHVL versus 2.9% (2/70) low-grade DNAemia patients (P = 0.002). EBV DNAemia developed in 32 EBV seronegative recipients (32/59; 54%); clearance was achieved in 70% (14/20) with low-grade DNAemia but no CHVL (0/12; P = 0.0001). Conclusions. CHVL was uncommon and appeared to occur after primary EBV infection. Future studies should explore other potentially modifiable risk factors for PTLD, including optimal management of EBV DNAemia.

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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