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

TitleImpact of Epstein-Barr virus donor and recipient serostatus on the incidence of post-transplant lymphoproliferative disorder in kidney transplant recipients.
Publication TypeJournal Article
Year of Publication2012
AuthorsSampaio MS, Cho YW, Shah T, Bunnapradist S, Hutchinson IV
JournalNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association// Nephrol Dial Transplant
Volume27
Issue7
Pagination2971 - 9
Date Published2012//
ISBN Number1460-2385
Other Numbersn7j, 8706402
Keywords*Graft Rejection/dt [Drug Therapy], *Herpesvirus 4, Human, *Kidney Transplantation/ae [Adverse Effects], *Lymphoproliferative Disorders/bl [Blood], *Lymphoproliferative Disorders/ep [Epidemiology], *Postoperative Complications, *Renal Insufficiency, Chronic/co [Complications], Adolescent, Adult, Child, Epstein-Barr Virus Infections/bl [Blood], Epstein-Barr Virus Infections/vi [Virology], Female, Follow-Up Studies, Glomerular Filtration Rate, Graft Rejection/et [Etiology], Graft Survival, Humans, Incidence, Los Angeles/ep [Epidemiology], Lymphoproliferative Disorders/et [Etiology], Male, Middle Aged, Prognosis, Renal Insufficiency, Chronic/mo [Mortality], Renal Insufficiency, Chronic/su [Surgery], Secondary Prevention, Survival Rate, Tissue Donors, Young Adult
Abstract

BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of transplantation., METHODS: 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., RESULTS: 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., CONCLUSION: 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.
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