Background: EBV-associated PTLD is a life-threatening complication to transplantation; associated with emerging EBV DNAemia. However, the benefit of a pre-emptive strategy based on regular screening for EBV DNA and early treatment is uncertain. This study compares EBV DNAemia dynamics in a cohort of solid organ (SOT) and hematopoietic stem cell (HSCT) transplant recipients.
Methods: Among consecutive transplant recipients at our hospital since 2004, patients with a first confirmed positive EBV DNA PCR in plasma were identified. The EBV doubling time could be calculated in patients were the viral load continued to increase after the first EBV DNAemia. EBV DNAemia episodes were characterized and association with PTLD development explored.
Results: 48% (1370/2852) of the recipients were screened for EBV DNA, of these 7% (99/1370) (4% (33/848) of SOT vs 13% (66/522) of HSCT recipients) developed EBV DNAemia. Gender and age were comparable between type of transplantation, however EBV DNAemia occurred earlier for HSCT than for SOT (p=0.001) (table 1). PTLD was diagnosed a median of 12 days after EBV DNAemia was first detected in 32% (32/99) episodes. Age and type of transplantation was comparable for those with and without development of PTLD, whereas the first and peak EBV DNAemia level was higher for those that developed PTLD (p<0.001) (table 2). 9/32 PTLD cases had an initial EBV DNAemia level ≤ 500 copies/mL, and 31% had been screened with negative PCR results within 2 weeks prior. The EBV doubling time could be calculated in 44 recipients, and was not influenced by episodes PTLD (table 2).
Conclusion: EBV DNAemia occurs rarely in transplant recipients, most often in teenagers, and 1/3 is associated with PTLD diagnosed concomitantly. 1/3 of PTLD cases were screened for EBV by PCR within last 2 weeks and 1/3 presented with low EBV DNAemia levels. Patient characteristics and the kinetics of EBV DNAemia evolution were comparable between recipients who developed PTLD and those who did not. More sensitive and discriminatory screening tools are needed in order to diagnose PTLD earlier.
N. E. Wareham,
H. Sengeløv, None
S. Schwartz Sørensen, None
F. Gustafsson, None
M. Iversen, None
A. Rasmussen, None
C. Da Cunha-Bang, None
J. Lundgren, None
See more of: Poster Abstract Session