Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, ANNALS-24-00165. https://doi.org/10.7326/ANNALS-24-00165 Dr. Vishnu S. Potluri et al.
Points
- Epstein-Barr virus (EBV) D+/R− kidney transplant recipients had a 22.1% incidence of PTLD, with cases occurring at a median of 202 days post-transplant.
- Nearly half (48.1%) of EBV D+/R− recipients developed EBV DNAemia, typically around 198 days post-transplant.
- EBV D+/R− recipients had a significantly higher risk of all-cause graft failure (HR 2.21, 95% CI 1.06–4.63) than EBV R+ recipients.
- Mortality was higher in the EBV D+/R− group, but the difference was insignificant (HR 2.19, 95% CI 0.94–5.13).
- The findings highlight the need for risk-mitigation strategies in EBV D+/R− kidney transplant recipients, given their elevated PTLD and graft failure risks.
Summary
This retrospective cohort study investigated the association between pretransplant Epstein-Barr virus (EBV) donor-recipient serostatus and posttransplant lymphoproliferative disorder (PTLD) outcomes and patient and graft survival in adult kidney transplant recipients. Conducted across two U.S. transplant centers, the study involved 104 EBV D+/R− recipients matched to 312 EBV R+ recipients, with the exposure being the pretransplant EBV serostatus of both the donor and recipient. The primary outcome was biopsy-proven PTLD, and secondary outcomes included all-cause graft failure and patient mortality, with follow-up truncated to three years post-transplant.
The study found that among EBV D+/R− recipients, 23 (22.1%) developed PTLD at a median of 202 days post-transplant (IQR, 118-317 days). Furthermore, 50 (48.1%) EBV D+/R− recipients developed EBV DNAemia at a median of 198 days (IQR, 110-282 days) after transplantation. Compared to EBV R+ recipients, EBV D+/R− recipients had a significantly higher risk of all-cause graft failure, with a hazard ratio (HR) of 2.21 (95% CI, 1.06–4.63). Mortality was also higher in the EBV D+/R− group, though not statistically significant (HR, 2.19 [95% CI, 0.94–5.13]).
This study demonstrates that EBV D+/R− kidney transplant recipients face a markedly higher risk of developing PTLD compared to EBV R+ recipients, with a 5- to 10-fold higher cumulative incidence. The results underscore the need for strategies to mitigate the risk of PTLD in this population, as these patients also experience a higher risk of graft failure and potentially increased mortality.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00165
References Potluri, V. S., Zhang, S., Schaubel, D. E., Shaikhouni, S., Blumberg, E. A., Nasta, S. D., Bloom, R. D., Cruz-Peralta, M., Mehta, R. B., Lavu, N. R., Getachew, B., Tandukar, S., Reese, P. P., & Puttarajappa, C. M. (2025). The association of epstein–barr virus donor and recipient serostatus with outcomes after kidney transplantation: A retrospective cohort study. Annals of Internal Medicine, ANNALS-24-00165. https://doi.org/10.7326/ANNALS-24-00165
