Decreased Post Heart Transplant Survival with Epstein-Barr Virus Mismatch in the Current Era
M. Kittleson, J. Patel, E. Kransdorf, S. Dimbil, R. Levine, S. Mersola, D. Geft, D. Chang, L. Czer, J. Kobashigawa.
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 October 11, 2024.« Back to 2018 American Transplant Congress