Status:
Ready to upload
Record number:
1400
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
This was a single case from a group of 8 transplant patients who developed EBV infection per-transplant; 3 developed lymphoproliferatative disease within 4 months of transplant; one of these was the subject patient who was an EBV-seronegative recipient of a liver from an EBV-seronegative donor. The patient was investigated to evaluate the possibility of transfusion transmission.
Time to detection:
1 month
Alerting signals, symptoms, evidence of occurrence:
Prolonged fever and fatigue, lymphoproliferative disease, seropositivity and cell-associated viremia 5-6 weeks post-transplant. Despite treatment, symptoms continued and one week later, liver biopsy showed massive infiltration with immunoblasts. High CD8 levels (relative to CD4) were observed 3 months post-transplant. Five to 6 weeks post-transplant, heterophile antibodies became positive and the patient's blood was found to contain a high number of EBV-infected B-cells. Eight of 9 blood donors were EBV-seropositive. Subsequently, lymphoid cell lines were established from the patient and four of the donors and viral DNA sequence identity was established between the patient isolate and that from one of the donors. That donor reported having had mononucleosis 15 months prior to donation.
Demonstration of imputability or root cause:
Isolation of EBV (via establishment of lymphoid cell lines) from patient and seropositive blood donors, DNA subunit and sequence identity demonstrated for patient and one donor; donor had history of relatively recent mononucleosis.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest references:
Alfieri, C., Tanner, J., Carpentier, L., Perpete, C., Savoie, A., Paradis, K., Delage, G., and Joncas, J. (1996). Epstein-Barr virus transmission from a blood donor to an organ transplant recipient with recovery of the same virus strain from the recipient's blood and oropharynx Blood 87(2):812-817.
Note:
This is a case of an EBV negative liver recipient who received an EBV-negative organ. The recipient was transfused with EBV positive blood donors and developed PTLD 4 months after transplantation. I believe this case should be assigned to the transfusion group