Lower Rates of Epstein-Barr Virus Viremia and Post-Transplant Lymphoproliferative Disease in Pediatric Solid Organ Transplant Recipients Who Received Valganciclovir Prophylaxis

E. A. Moulton¹, M. Karandikar², S. Bond³, S. Burchett², T. Sharma², F. M. Marty³

¹Baylor College of Medicine, Houston, TX, ²Boston Children's Hospital, Boston, MA, ³Brigham and Women's Hospital, Boston, MA

Meeting: 2019 American Transplant Congress

Abstract number: 49

Keywords: Epstein-Barr virus (EBV), Ganciclovir, Polymerase chain reaction (PCR), Post-transplant lymphoproliferative disorder (PTLD)

Session Information

Session Name: Concurrent Session: PTLD/Malignancies: All Topics

Session Type: Concurrent Session

Date: Sunday, June 2, 2019

Session Time: 2:30pm-4:00pm

Presentation Time: 2:54pm-3:06pm

Location: Room 311

*Purpose: Antiviral prophylaxis to prevent post-transplant lymphoproliferative disease (PTLD) remains controversial, but some data suggest that valganciclovir or ganciclovir use in Epstein-Barr virus (EBV) high-risk pediatric renal transplants reduces EBV viremia. We evaluated the impact of valganciclovir on EBV viremia and PTLD in pediatric non-renal solid organ transplant (SOT) recipients.

*Methods: Retrospective study of 166 patients who underwent a first heart, liver, lung, intestine, multi-visceral, or dual organ SOT between 11/2011 and 11/2016 at a Children’s Hospital who survived without re-transplantation for at least 30 days. Data collected included EBV donor/recipient serostatus, donor’s age >2 years-old (to avoid misclassification of EBV risk due to maternal antibody), antiviral use (valganciclovir or acyclovir), time to EBV viremia (>1000 copies/mL by whole blood PCR), and time to PTLD. EBV high-risk patients were those with EBV seropositive donor [D+]/ EBV seronegative recipient [R-] (n=72); intermediate-risk were EBV R+ (n=38); low-risk were EBV D-/R- (n=37). Time-to-event analyses using the Kaplan-Meier method were performed and significance (p=0.05) was evaluated using the log-rank test.

*Results: Higher rates of EBV viremia were associated with high (38/72) or intermediate (21/38) EBV risk compared to low EBV risk (4/37, p=0.0001). EBV viremia rate was lower in the subgroup of high EBV risk patients with donors >2 years-old who received valganciclovir (56%, 22/39) versus those who received acyclovir (8/10) or no antiviral (5/5; p=0.004). Most PTLD cases (14/18) occurred in the high EBV risk group (p=0.02). High EBV risk patients with donors >2 years-old who received valganciclovir had significantly less PTLD (13%, 5/39) than those who received acyclovir (50%, 5/10) or no antiviral (40%, 2/5; p=0.003).

*Conclusions: Lower rates of EBV viremia and PTLD occurred in high EBV risk transplant recipients who received valganciclovir, possibly by preventing lytic cycle replication from donor cells and/or primary EBV infection.

To cite this abstract in AMA style:

Moulton EA, Karandikar M, Bond S, Burchett S, Sharma T, Marty FM. Lower Rates of Epstein-Barr Virus Viremia and Post-Transplant Lymphoproliferative Disease in Pediatric Solid Organ Transplant Recipients Who Received Valganciclovir Prophylaxis [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/lower-rates-of-epstein-barr-virus-viremia-and-post-transplant-lymphoproliferative-disease-in-pediatric-solid-organ-transplant-recipients-who-received-valganciclovir-prophylaxis/. Accessed May 18, 2025.

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