Primary Epstein-Barr virus infection, seroconversion, and post-transplant lymphoproliferative disorder in seronegative renal allograft recipients: a prospective cohort study

Background Epstein–Barr virus (EBV)‐seronegative renal transplant recipients are at risk of post‐transplant lymphoproliferative disorder (PTLD). We compared primary EBV infection, seroconversion, and PTLD in EBV‐seronegative patients who received renal allograft from seropositive or seronegative donors (D+/R− and D−/R−, respectively). Methods We prospectively followed 25 D+/R− and 8 D−/R− recipients. We followed patients from January 1999 to June 2009 with clinical visits, monthly EBV polymerase chain reaction tests, and serologic tests for a period of 1 year after kidney transplantation and on an individual basis thereafter. Results Three patients (9%) developed PTLD including 2 early‐onset (12 months) disease. In D+/R− and D−/R− patients, the frequencies of PTLD (8% vs. 12.5%, P = 0.7), EBV seroconversion (64% vs. 50%, P = 0.4), and EBV viremia (40% vs. 25%, P = 0.6) were not significantly different. Clinical, serologic, and virologic surveillance as well as reduction in immunosuppression after evidence of primary EBV infection resulted in a PTLD rate of 9%, despite a seroconversion rate of 60.6%. Rate of graft loss after reduction in immunosuppression was 10% (2 of 20), which was not significantly different from 13 patients without EBV seroconversion (no graft loss, P = 0.5). Rates of viremia, seroconversion, and PTLD in D+/R− and D−/R− patients appear to be similar. Conclusions The incidence of PTLD in renal transplants ranges from 0.5% to 2.9%. Our data show a significantly higher rate in EBV‐seronegative renal allograft recipients, suggesting the need for close surveillance. Our data also suggest that donors for EBV‐seronegative recipients may be accepted irrespective of positive or negative serostatus, with ongoing surveillance important in either circumstance.