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 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 December 7, 2019.
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