Cytomegalovirus after Kidney Transplantation: A Case Review

Cytomegalovirus is the most common infectious complication in solid-organ transplant recipients. Despite the frequency of the problem, no commonly accepted approach to cytomegalovirus prophylaxis and treatment exists. Because cytomegalovirus may lead to the modulation of the immune system sometimes causing opportunistic superinfections, allograft injury, acute rejection, chronic rejection, and development of posttransplant lymphoproliferative disease, transplant coordinators require knowledge of the disease, diagnostic methods, and treatment and prophylaxis strategies. This case study reviews a high-risk cytomegalovirus transplant recipient after living-related kidney transplantation. In addition to a review of the pathophysiology of the disease process, patient, family, and nursing staff education, and cultural and psychosocial aspects of cytomegalovirus, prophylaxis, diagnosis, treatment strategies as well as role of the transplant coordinator, will be discussed.

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Posttransplant Lymphoproliferative Disease Presenting as an Extracranial Mass

Case Reports in Transplantation ◽

10.1155/2017/6401086 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Reuben J. Arasaratnam ◽

Alejandro Restrepo

Keyword(s):

Soft Tissue ◽

Early Recognition ◽

Solid Organ Transplantation ◽

Organ Transplant ◽

Antibody Therapy ◽

B Cell Lymphoma ◽

Lymphoproliferative Disease ◽

Solid Organ ◽

Tissue Mass ◽

Posttransplant Lymphoproliferative Disease

Posttransplant lymphoproliferative disease is a serious complication following stem cell and solid organ transplantation. Early recognition of the disease is important in facilitating timely therapy and improving long-term outcomes. We report a renal transplant recipient presenting with an extracranial frontoparietal soft tissue mass that was subsequently diagnosed as a B-cell lymphoma. The patient was treated successfully with immunosuppression reduction, anti-CD20 monoclonal antibody therapy, and cytotoxic chemotherapy. Our case highlights the importance of recognizing soft tissue masses in the head and neck as a potential clinical manifestation of PTLD in solid organ transplant recipients.

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Increased levels of circulating Epstein-Barr virus (EBV)-infected lymphocytes and decreased EBV nuclear antigen antibody responses are associated with the development of posttransplant lymphoproliferative disease in solid-organ transplant recipients

Blood ◽

10.1182/blood.v84.3.972.bloodjournal843972 ◽

1994 ◽

Vol 84 (3) ◽

pp. 972-984 ◽

Cited By ~ 5

Author(s):

SA Riddler ◽

MC Breinig ◽

JL McKnight

Keyword(s):

Epstein Barr Virus ◽

Organ Transplant ◽

Lymphoproliferative Disease ◽

Nuclear Antigen ◽

Solid Organ ◽

Transplant Recipients ◽

Barr Virus ◽

Posttransplant Lymphoproliferative Disease ◽

Solid Organ Transplant Recipients ◽

Epstein Barr

Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disease (PTLD) is an uncommon but potentially fatal complication of immunosuppression in solid-organ transplant recipients. A semiquantitative DNA polymerase chain reaction assay was developed to amplify a unique 269-bp region of the EBNA-1 gene in peripheral blood lymphocytes (PBL) using the primers described by Telenti et al (J Clin Microbiol 28:2187, 1990). Serial samples were studied from 23 transplant recipients, 12 of whom were diagnosed with PTLD. The majority of transplant recipients who were EBV seropositive at the time of transplant surgery and who did not develop PTLD (5 of 7, 71%) exhibited less than a 10-fold increase in the levels of EBV-infected PBL over the 0.1 to 5 EBV genomes/10(6) PBL observed in immunocompetent EBV seropositive controls. Transplant recipients who were seronegative at the time of transplantation and who underwent a primary EBV infection but did not develop PTLD exhibited a reduced capacity to control viremia because the levels of EBV-infected PBL were up to 400 times greater than the 1.0 to 50 EBV genomes/10(6) PBL observed in individuals undergoing acute infectious mononucleosis (Rocci et al: N Engl J Med 296:132, 1977). However, all transplant recipients who developed PTLD exhibited a marked elevation of EBV-infected PBL independent of their serologic state at the time of transplantation. Six of the 10 transplant recipients with PTLD exhibited > or = 300,000 EBV genomes/10(5) PBL, two exhibited 10,000 to 50,000 EBV-infected genomes/10(5) PBL, and one each exhibited 2,500 and 500 EBV genomes/10(5) PBL. However, the latter two samples were obtained 4 to 5 weeks after the diagnosis of PTLD and may reflect a decrease in viral load resulting from immunomodulation. Marked decreases in the levels of EBV nuclear antigen-1 (EBNA-1), EBNA-2, and EBNA-LP antibodies correlated with the increase in EBV-infected PBL. Hence, a quantitative difference in circulating EBV viral load and EBNA antibody levels is evident between transplant recipients with and without PTLD and may be useful as a noninvasive prognostic marker with which to monitor and/or predict the development of PTLD.

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Activation and adoptive transfer of Epstein-Barr virus-specific cytotoxic T cells in solid organ transplant patients with posttransplant lymphoproliferative disease

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.96.18.10391 ◽

1999 ◽

Vol 96 (18) ◽

pp. 10391-10396 ◽

Cited By ~ 231

Author(s):

R. Khanna ◽

S. Bell ◽

M. Sherritt ◽

A. Galbraith ◽

S. R. Burrows ◽

...

Keyword(s):

Epstein Barr Virus ◽

Cytotoxic T Cells ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Lymphoproliferative Disease ◽

Solid Organ ◽

Barr Virus ◽

Transplant Patients ◽

Posttransplant Lymphoproliferative Disease ◽

Epstein Barr

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Identifying Predictive Factors for Posttransplant Lymphoproliferative Disease in Pediatric Solid Organ Transplant Recipients With Epstein-Barr Virus Viremia

Journal of Pediatric Hematology/Oncology ◽

10.1097/mph.0000000000000178 ◽

2014 ◽

Vol 36 (8) ◽

pp. e481-e486 ◽

Cited By ~ 10

Author(s):

Lauren Weintraub ◽

Chana Weiner ◽

Tamir Miloh ◽

Juli Tomaino ◽

Umesh Joashi ◽

...

Keyword(s):

Epstein Barr Virus ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Lymphoproliferative Disease ◽

Solid Organ ◽

Transplant Recipients ◽

Barr Virus ◽

Posttransplant Lymphoproliferative Disease ◽

Solid Organ Transplant Recipients ◽

Epstein Barr

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Real-world Outcomes With Rituximab-based Therapy for Posttransplant Lymphoproliferative Disease Arising After Solid Organ Transplant

Transplantation Journal ◽

10.1097/tp.0000000000003183 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 1

Author(s):

David M. Burns ◽

Katherine Clesham ◽

Yan A. Hodgson ◽

Lynsey Fredrick ◽

Joanna Haughton ◽

...

Keyword(s):

Real World ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Lymphoproliferative Disease ◽

Solid Organ ◽

Posttransplant Lymphoproliferative Disease

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Increased levels of circulating Epstein-Barr virus (EBV)-infected lymphocytes and decreased EBV nuclear antigen antibody responses are associated with the development of posttransplant lymphoproliferative disease in solid-organ transplant recipients

Blood ◽

10.1182/blood.v84.3.972.972 ◽

1994 ◽

Vol 84 (3) ◽

pp. 972-984 ◽

Cited By ~ 234

Author(s):

SA Riddler ◽

MC Breinig ◽

JL McKnight

Keyword(s):

Epstein Barr Virus ◽

Organ Transplant ◽

Lymphoproliferative Disease ◽

Nuclear Antigen ◽

Solid Organ ◽

Transplant Recipients ◽

Barr Virus ◽

Posttransplant Lymphoproliferative Disease ◽

Solid Organ Transplant Recipients ◽

Epstein Barr

Abstract Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disease (PTLD) is an uncommon but potentially fatal complication of immunosuppression in solid-organ transplant recipients. A semiquantitative DNA polymerase chain reaction assay was developed to amplify a unique 269-bp region of the EBNA-1 gene in peripheral blood lymphocytes (PBL) using the primers described by Telenti et al (J Clin Microbiol 28:2187, 1990). Serial samples were studied from 23 transplant recipients, 12 of whom were diagnosed with PTLD. The majority of transplant recipients who were EBV seropositive at the time of transplant surgery and who did not develop PTLD (5 of 7, 71%) exhibited less than a 10-fold increase in the levels of EBV-infected PBL over the 0.1 to 5 EBV genomes/10(6) PBL observed in immunocompetent EBV seropositive controls. Transplant recipients who were seronegative at the time of transplantation and who underwent a primary EBV infection but did not develop PTLD exhibited a reduced capacity to control viremia because the levels of EBV-infected PBL were up to 400 times greater than the 1.0 to 50 EBV genomes/10(6) PBL observed in individuals undergoing acute infectious mononucleosis (Rocci et al: N Engl J Med 296:132, 1977). However, all transplant recipients who developed PTLD exhibited a marked elevation of EBV-infected PBL independent of their serologic state at the time of transplantation. Six of the 10 transplant recipients with PTLD exhibited > or = 300,000 EBV genomes/10(5) PBL, two exhibited 10,000 to 50,000 EBV-infected genomes/10(5) PBL, and one each exhibited 2,500 and 500 EBV genomes/10(5) PBL. However, the latter two samples were obtained 4 to 5 weeks after the diagnosis of PTLD and may reflect a decrease in viral load resulting from immunomodulation. Marked decreases in the levels of EBV nuclear antigen-1 (EBNA-1), EBNA-2, and EBNA-LP antibodies correlated with the increase in EBV-infected PBL. Hence, a quantitative difference in circulating EBV viral load and EBNA antibody levels is evident between transplant recipients with and without PTLD and may be useful as a noninvasive prognostic marker with which to monitor and/or predict the development of PTLD.

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Posttransplant Lymphoproliferative Disease after Pediatric Solid Organ Transplantation

Clinical and Developmental Immunology ◽

10.1155/2013/814973 ◽

2013 ◽

Vol 2013 ◽

pp. 1-14 ◽

Cited By ~ 51

Author(s):

Martin Mynarek ◽

Tilmann Schober ◽

Uta Behrends ◽

Britta Maecker-Kolhoff

Keyword(s):

Organ Transplantation ◽

Solid Organ Transplantation ◽

Treatment Strategies ◽

Lymphoproliferative Disease ◽

Treatment Modalities ◽

Solid Organ ◽

Increased Risk ◽

Posttransplant Lymphoproliferative Disease ◽

New Treatment ◽

Anti Cd20

Patients after solid organ transplantation (SOT) carry a substantially increased risk to develop malignant lymphomas. This is in part due to the immunosuppression required to maintain the function of the organ graft. Depending on the transplanted organ, up to 15% of pediatric transplant recipients acquire posttransplant lymphoproliferative disease (PTLD), and eventually 20% of those succumb to the disease. Early diagnosis of PTLD is often hampered by the unspecific symptoms and the difficult differential diagnosis, which includes atypical infections as well as graft rejection. Treatment of PTLD is limited by the high vulnerability towards antineoplastic chemotherapy in transplanted children. However, new treatment strategies and especially the introduction of the monoclonal anti-CD20 antibody rituximab have dramatically improved outcomes of PTLD. This review discusses risk factors for the development of PTLD in children, summarizes current approaches to therapy, and gives an outlook on developing new treatment modalities like targeted therapy with virus-specific T cells. Finally, monitoring strategies are evaluated.

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