EBV-negative post-transplant lymphoproliferative disorder: Clinical characteristics, response to therapy, and survival.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8578-8578
Author(s):  
Daniel S. Heil ◽  
Marlise Rachael Luskin ◽  
Edward Allen Stadtmauer ◽  
Stephen J. Schuster ◽  
Donald Edward Tsai ◽  
...  
Keyword(s):  
Lymphoproliferative Disorder ◽  
Survival Rates ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Response Rates ◽  
Response To Therapy ◽  
Solid Organ ◽  
Post Transplant ◽  
Barr Virus ◽  
Epstein Barr

8578 Background: Post-transplant lymphoproliferative disorder (PTLD) is a potentially life-threatening complication of solid organ transplantation. PTLD is frequently linked with Epstein-Barr virus (EBV) and it was suggested that EBV negativity is associated with a poor prognosis and lack of response to reduction of immunosuppression (RI). We conducted a case-control study to identify the characteristics, outcome and response to therapy of EBVpos and EBVneg PTLD over a 20-year period. Methods: We reviewed data on patients diagnosed with PTLD at U. Penn. between 1982 and 2012. We determined EBV positivity on tumor samples according to WHO criteria. We compared clinical and pathologic characteristics, response to therapy, and survival of EBVpos and EBVneg patients. Results: Of 222 patients diagnosed with PTLD, we verified the EBV status of 169 patients, of whom 35% were EBVneg and 65% were EBVpos. Mean follow-up was 46.7 months. Median time from transplant to PTLD was 23.1 mo. in EBVpos vs. 59.3 mo. in EBVneg (p=0.003) with 42% of EBVpos patients being diagnosed within the first year after transplant vs. 15% in the EBVneg group (p<0.001). EBVneg PTLD was more likely to occur in non-thoracic vs. thoracic transplants (p=0.006). 28% of patients with EBVpos PTLD presented with disease originating from the graft vs. 14% in the EBVneg group (p=0.03). In terms of histology, 36% of EBVpos patients had polymorphic PTLD vs. 7% of EBVneg patients (p<0.001). Of patients who were treated with RI alone (40% of patients in both groups), the overall response rates were 50% and 48% in EBVpos and EBVneg patients respectively (p=NS). Response rates to rituximab were also similar. There was no difference in the mortality risk between groups (HR=1.04; p=0.84). The 5-year survival rates were 47% and 51% in EBVpos and EBVneg PTLD respectively (p=NS). Conclusions: In a large single-center series, EBVneg PTLD was associated with late occurrence after transplant, monomorphic histology and similar outcome in comparison with EBVpos PTLD. Importantly, the response of EBVneg PTLD to RI and rituximab was no different than EBVpos PTLD. These results have implications for the management of solid organ transplant recipients with PTLD.

Epstein-Barr Virus Polymerase Chain Reaction and Serology in Pediatric Post-Transplant Lymphoproliferative Disorder: Three-Year Experience

1998 ◽  
Vol 1 (6) ◽  
pp. 480-486 ◽  
Author(s):  
Beverly Barton Rogers ◽  
John Sommerauer ◽  
Albert Quan ◽  
Charles F. Timmons ◽  
D. Brian Dawson ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Lymphoproliferative Disorder ◽  
Epstein Barr Virus ◽  
Response To Therapy ◽  
Chain Reaction ◽  
Post Transplant ◽  
Barr Virus ◽  
Polymerase Chain ◽  
Epstein Barr ◽  
Pcr Test

To assess whether the semiquantitative peripheral blood Epstein-Barr virus (EBV) polymerase chain reaction (PCR) test correlates with post-transplant lymphoproliferative disorder (LPD), we compiled the results of the test done over a 3-year period ending July 1997. Six hundred seventy-six tests were done on 185 patients. Four hundred-thirty tests (63%) were negative, 167 (25%) were weak positive, 67 (10%) were moderate positive, and 12 (2%) were strong positive. Twelve of the patients developed a lymphoproliferative disorder (LPD) during this time. The EBV PCR tests proximate to the diagnosis of LPD in the 12 patients with EBV-positive LPD were 6 strong positive, 5 moderate positive, 1 weak positive. No patient with LPD had a negative result at diagnosis. Stated another way, 6/12 (50%) of strong-positive PCR tests, 5/67 (7%) moderate-positive tests, and 1/167 (.6%) of weak-positive tests correlated with LPD. Serologic evaluation for EBV done on 7 patients at the time of LPD showed low serologic responses in 5 of the 7 patients. The EBV PCR temporally associated with the serology indicated moderate to large viral burdens. In each patient evaluated serially, the EBV PCR test rose before the diagnosis of LPD and fell with treatment for the disorder. In conclusion, the EBV PCR test may be used as an adjunct to the diagnosis of patients with LPD and may be used to monitor response to therapy for the disorder.

scholarly journals Long-Term Infectious Complications of Kidney Transplantation

2021 ◽  
pp. CJN.15971020
Author(s):  
Akansha Agrawal ◽  
Michael G. Ison ◽  
Lara Danziger-Isakov
Keyword(s):  
Opportunistic Infections ◽  
Fungal Infections ◽  
Solid Organ Transplantation ◽  
Infectious Complications ◽  
Solid Organ ◽  
Post Transplant ◽  
Barr Virus ◽  
Clostridioides Difficile ◽  
Epstein Barr ◽  
Tract Infections

Infections remain a common complication of solid-organ transplantation. Most infections in the first month after transplant are typically health care–associated infections, whereas late infections, beyond 6–12 months, are community-acquired infections. Opportunistic infections most frequently present in the first 12 months post-transplant and can be modulated on prior exposures and use of prophylaxis. In this review, we summarize the current epidemiology of postkidney transplant infections with a focus on key viral (BK polyomavirus, cytomegalovirus, Epstein-Barr virus, and norovirus), bacterial (urinary tract infections and Clostridioides difficile colitis), and fungal infections. Current guidelines for safe living post-transplant are also summarized. Literature supporting prophylaxis and vaccination is also provided.

scholarly journals Analysis of Post-Transplant Lymphoproliferative Disorder (PTLD) Outcomes with Epstein–Barr Virus (EBV) Assessments—A Single Tertiary Referral Center Experience and Review of Literature

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 899
Author(s):  
Eric Lau ◽  
Justin Tyler Moyers ◽  
Billy Chen Wang ◽  
Il Seok Daniel Jeong ◽  
Joanne Lee ◽  
...  
Keyword(s):  
Epstein Barr Virus ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Allogeneic Bone ◽  
Hematopoietic Stem ◽  
Tertiary Referral Center ◽  
Post Transplant ◽  
Barr Virus ◽  
Significant Difference ◽  
Epstein Barr

Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations ranging from polyclonal reactive proliferations to overt lymphomas that develop as consequence of immunosuppression in recipients of solid organ transplantation (SOT) or allogeneic bone marrow/hematopoietic stem cell transplantation. Immunosuppression and Epstein–Barr virus (EBV) infection are known risk factors for PTLD. Patients with documented histopathologic diagnosis of primary PTLD at our institution between January 2000 and October 2019 were studied. Sixty-six patients with PTLD following SOT were followed for a median of 9.0 years. The overall median time from transplant to PTLD diagnosis was 5.5 years, with infant transplants showing the longest time to diagnosis at 12.0 years, compared to pediatric and adolescent transplants at 4.0 years and adult transplants at 4.5 years. The median overall survival (OS) was 19.0 years. In the monomorphic diffuse large B-cell (M-DLBCL-PTLD) subtype, median OS was 10.7 years, while median OS for polymorphic subtype was not yet reached. There was no significant difference in OS in patients with M-DLBCL-PTLD stratified by quantitative EBV viral load over and under 100,000 copies/mL at time of diagnosis, although there was a trend towards worse prognosis in those with higher copies.

Utility of Head and Neck Biopsies in the Evaluation of Posttransplant Lymphoproliferative Disorder

2007 ◽  
Vol 137 (2) ◽  
pp. 296-300 ◽  
Author(s):  
Paolo Campisi ◽  
Upton D. Allen ◽  
Bo-Yee Ngan ◽  
Michael Hawkes ◽  
Vito Forte
Keyword(s):  
Head And Neck ◽  
Diagnostic Yield ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Neck Region ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Head And Neck Region ◽  
Barr Virus ◽  
Epstein Barr

OBJECTIVE: To determine the diagnostic yield of head and neck biopsies in the evaluation of PTLD in children and to explore whether this yield was related to pretransplant Epstein-Barr virus (EBV) serostatus. STUDY DESIGN: This is a retrospective study of pediatric, post-solid-organ transplant recipients who have undergone a biopsy in the head and neck region to establish a diagnosis of PTLD. RESULTS: Fifty-six biopsies were performed in 46 patients four to 120 months after solid-organ transplantation. Biopsies yielded PTLD in 39.1% of patients. The odds of developing PTLD if a patient was seropositive for EBV at the time of transplantation was 0.26 (95% confidence interval, 0.064-1.056; P = 0.054). CONCLUSIONS: The high diagnostic yield of PTLD suggests that biopsies should be performed if PTLD is suspected in pediatric posttransplant patients. The results demonstrate a trend toward lower risk of PTLD among patients with pretransplant exposure to EBV.

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