Introduction: While EBV seronegative recipients have a high risk of early PTLD knowledge is lacking regarding the implications of EBV DNAemia in stable patients in the late post-transplant period. We aimed to investigate the relevance of EBV DNAaemia on subsequent long term clinical outcomes.

Methods: In this single centre observational study stable adult kidney transplant recipients were screened at recruitment and 4 monthly for EBV DNA in blood (copies/ml) and classified after 1 year as undetectable (UVL), low level (LVL), and high level viral load (HVL) carriers. Long term follow up of participants was performed with analysis made of patient and graft survival and cancer diagnosis including non-melanoma skin cancer (NMSC) and PTLD.

Results: We recruited 499 patients of which 62% were male, 93% white, 6% with ATG use, and median age (IQR): 52 years (42-61), time from transplant: 7 years (2.5-12.3) and follow up after recruitment: 6.8 years (5.2-7.0). During follow up 19% patients died and 9% experienced graft failure. While initial assessment of EBV DNA status at recruitment (31% positive) did not significantly affect patient or graft survival, persistently UVL patients had lowest inter-group mortality at 13% (31/234) OR=0.58, p=0.036, and HVL greatest (5/31 (16%)). NMSC was diagnosed in 102 (20%) patients including 9/31 (29%) HVL and 44/234 (18.8%) UVL. Death occurred in 25% NMSC patients with detection of EBV DNA at recruitment associated with worse survival following diagnosis (p=0.002). Death occurred for example in 37.5% EBV DNA recruitment positive Squamous Cell cancer cases v 13.6% DNA recruitment negative. PTLD was diagnosed in 14 patients during follow up (57% cases EBV positive) including 3/31 (9.7%) with HVL, OR: 3.94 (p=0.044) and 4/234 (1.7%) UVL. Other cancers were diagnosed in 6% patients with no association with prior EBV infection status.

Conclusions: While single timepoint assessments of EBV DNAemia do not significantly associate with overall patient survival, DNAemia, in particular chronic HVL carriage, may predict NMSC and PTLD development and poorer outcomes after skin cancer diagnosis.

CITATION INFORMATION: Morton M., Scullin G., Daga K., Klapper P., Vallely P., Picton M. Survival, Cancer and PTLD Diagnosis after Late EBV Infection in Adult Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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