Do We Need to Worry about EBV DNAemia in the Late Post-Transplant Period?
1Department of Renal Medicine, Manchester Royal Infirmary, Manchester, United Kingdom
2University of Manchester, Manchester, United Kingdom.
Meeting: 2018 American Transplant Congress
Abstract number: A181
Keywords: Epstein-Barr virus (EBV), Immunosuppression, Kidney transplantation, Post-transplant malignancy
Session Information
Session Name: Poster Session A: Kidney Transplant Goes Viral
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Background: Despite detectable Epstein-Barr virus (EBV) in blood, kidney transplant patients (KTR) may have no apparent clinical consequence. This study aims to explore the clinical relevance of EBV DNAemia in the late post-transplant period.
Methods: This observational study recruited 60 KTRs, with a history of previous undetectable (UVL) (n=19), transient/low (LVL) (n=20), and high (HVL) (n=21) whole blood (WB) EBV levels. Patients were matched for age and time from transplant. Symptom enquiry, plasma DNA, cervical lymphadenopathy (on ultrasound), and lymphocyte subsets were assessed and clinical outcomes were determined at long-term follow-up.
Results: There was no significant difference in symptoms between groups at recruitment. HVL patients had higher anti-VCA antibody levels (p=0.03) and more individuals with ≥2 cervical lymph nodes >5mm than other groups (p=0.049). Plasma DNA was detectable in those with WB DNAemia ≥log 3.47 copies/ml, and was associated with lower CD4:8 ratios (p=0.041). CD19 numbers were low in 66% of patients but not significantly different between EBV groups. Mycophenolate usage was lowest in the HVL group. UVL patients had lower tacrolimus and ciclosporin trough levels (p=0.03).
Median follow-up time was 6 years with no difference in patient or graft survival between groups. The HVL group had the only case of PTLD, higher numbers of patients with cancer, skin cancer, death and admissions, but lower diabetes incidence during follow-up. Numerically, plasma-positive patients had higher rates of death and cancer than plasma-negative patients.
Lymphocytes <1×109/L, low CD3 and CD19 counts were associated with higher mortality (p=0.01), but not cancer. Low B-cell counts protected from diabetes development (p=0.005).
Conclusions: In this exploratory study, EBV patterns had no clear impact on graft or patient survival. Chronic high whole blood and plasma viraemia may predict other adverse outcomes such as cancer development. Our study also identifies associations between lymphopenia and B-cell numbers with clinical outcomes post-transplant.
CITATION INFORMATION: Morton M., Daga K., Klapper P., Picton M., Vallely P. Do We Need to Worry about EBV DNAemia in the Late Post-Transplant Period? Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Morton M, Daga K, Klapper P, Picton M, Vallely P. Do We Need to Worry about EBV DNAemia in the Late Post-Transplant Period? [abstract]. https://atcmeetingabstracts.com/abstract/do-we-need-to-worry-about-ebv-dnaemia-in-the-late-post-transplant-period/. Accessed November 21, 2024.« Back to 2018 American Transplant Congress