Decreased Post Heart Transplant Survival with Epstein-Barr Virus Mismatch in the Current Era
Cedars Sinai Medical Center, Los Angeles.
Meeting: 2018 American Transplant Congress
Abstract number: B66
Keywords: Epstein-Barr virus (EBV), Heart transplant patients, Outcome, Post-transplant malignancy
Session Information
Session Name: Poster Session B: Heart and VADs: All Topics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Purpose: Epstein-Barr virus (EBV) has been implicated in a multitude of cancers, including B-cell lymphoma, Burkitt's lymphoma, CNS lymphoma, gastric cancer and nasopharyngeal carcinoma. Previous research has suggested that EBV mismatch (donor positive/recipient negative) is a risk factor for the subsequent development of malignancy. We assessed whether EBV mismatch (D+/R-) is correlated with a higher incidence of cancer and worse outcome in heart transplant (HTx) patients (pts)
Methods: Between 2010-14, we assessed 336 HTx pts. This group was divided into pts with EBV mismatch (D+/R-, n=9) and pts without EBV mismatch (n=327). Endpoints included 3-year survival, 3-year freedom from post-transplant malignancy, 3-year freedom from cardiac allograft vasculopathy (CAV) (≥30% angiographic stenosis), 3-year freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), and 3-year freedom from any-treated rejection (ATR), acute cellular rejection (ACR) and antibody-mediated rejection (AMR).
Results: Pts with EBV mismatch had a significantly reduced 3-year survival (66.7% vs 88.4%, p=0.031). 3/3 pts who died in the EBV mismatch group died from heart failure. The 3-year freedom from post-transplant malignancy was 100.0% in the EBV mismatch group. There was no significant difference in 3-year freedom from CAV, NF-MACE, ATR, ACR, or AMR.
Conclusion: EBV mismatch appears to lead to increased mortality post-transplant. There is no increased risk for rejection, CAV, NF-MACE or the development of post-transplant malignancy in this population. Larger studies are warranted to confirm these findings and reconcile mechanisms of poor outcome.
| Endpoints | EBV Mismatch (D+/R-) (n=9) | No EBV Mismatch (n=327) | Log-Rank P-Value |
| 3-Yr Survival | 66.7% | 88.4% | 0.031 |
| 3-Yr Freedom from Post-Transplant Malignancy | 100.0% | 90.5% | 0.371 |
| 3-Yr Freedom from CAV | 88.9% | 87.8% | 0.916 |
| 3-Yr Freedom from NF-MACE | 88.9% | 94.5% | 0.391 |
| 3-Yr Freedom from Any Treated Rejection | 77.8% | 82.0% | 0.554 |
| 3-Yr Freedom from ACR | 88.9% | 91.7% | 0.677 |
| 3-Yr Freedom from AMR | 88.9 | 96.6% | 0.136 |
CITATION INFORMATION: Kittleson M., Patel J., Kransdorf E., Dimbil S., Levine R., Mersola S., Geft D., Chang D., Czer L., Kobashigawa J. Decreased Post Heart Transplant Survival with Epstein-Barr Virus Mismatch in the Current Era Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Kittleson M, Patel J, Kransdorf E, Dimbil S, Levine R, Mersola S, Geft D, Chang D, Czer L, Kobashigawa J. Decreased Post Heart Transplant Survival with Epstein-Barr Virus Mismatch in the Current Era [abstract]. https://atcmeetingabstracts.com/abstract/decreased-post-heart-transplant-survival-with-epstein-barr-virus-mismatch-in-the-current-era/. Accessed November 21, 2024.« Back to 2018 American Transplant Congress