• Ann. Intern. Med. · Jan 2025

    The Association of Epstein-Barr Virus Donor and Recipient Serostatus With Outcomes After Kidney Transplantation : A Retrospective Cohort Study.

    • Vishnu S Potluri, Siqi Zhang, Douglas E Schaubel, Salma Shaikhouni, Emily A Blumberg, Sunita D Nasta, Roy D Bloom, Massiel Cruz-Peralta, Rajil B Mehta, Nikhil R Lavu, Bereket Getachew, Srijan Tandukar, Peter P Reese, and Chethan M Puttarajappa.
    • Renal-Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania (V.S.P.).
    • Ann. Intern. Med. 2025 Jan 28.

    BackgroundPrior studies indicate that 1% to 4% of Epstein-Barr virus (EBV)-seronegative recipients of EBV-seropositive donor (EBV D+/R-) kidneys develop posttransplant lymphoproliferative disorder (PTLD). However, these estimates are based on limited data that lack granularity.ObjectiveTo determine the associations between pretransplant EBV D+/R- and recipient EBV-seropositive status (R+) and the outcomes of PTLD and graft and patient survival among adult kidney transplant recipients.DesignRetrospective cohort study.SettingTwo large U.S. transplant centers.ParticipantsEpstein-Barr virus D+/R- and EBV R+ recipients matched 1:3 on donor, recipient, and transplant characteristics between 1 January 2010 and 30 June 2022.MeasurementsExposure was pretransplant donor and recipient EBV serostatus. The primary outcome was biopsy-proven PTLD. Secondary outcomes were all-cause graft loss (death, retransplant, or graft failure) and death. Follow-up was truncated to 3 years after transplant.ResultsThe final cohort comprised 104 EBV D+/R- recipients matched to 312 EBV R+ recipients. The mean age was 42 years (SD, 17.1), 59% were living donor transplants, and 95% received thymoglobulin induction. Among EBV D+/R- recipients, 50 (48.1%) developed EBV DNAemia, with a median time of 198 days (IQR, 110 to 282 days) after transplantation. Posttransplant lymphoproliferative disorder occurred in 23 (22.1%) EBV D+/R- recipients at a median of 202 days (IQR, 118 to 317 days) after transplantation. Epstein-Barr virus D+/R- recipients had higher all-cause graft failure (hazard ratio, 2.21 [95% CI, 1.06 to 4.63]); mortality was higher but not statistically significant (hazard ratio, 2.19 [CI, 0.94 to 5.13]).LimitationTwo-center study.ConclusionCompared with previous studies, this study showed that EBV D+/R- kidney recipients face a 5- to 10-fold higher cumulative incidence of PTLD. Strategies to mitigate the PTLD risk are urgently needed.Primary Funding SourceNational Institutes of Health.

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