Ganciclovir and Acyclovir Reduce the Risk of Post‐Transplant Lymphoproliferative Disorder in Renal Transplant Recipients

Given its association with Epstein‐Barr virus (EBV), there is considerable interest in assessing the impact of prophylactic anti‐viral therapy on post‐transplant lymphoproliferative disorder (PTLD). A recently completed multi center case–control study assessed the impact of immunosuppressive therapy on PTLD risk among renal transplant patients and collected information on the use of anti‐viral therapy. Biopsy‐confirmed PTLD cases (n = 100) were matched to 375 controls by center, date of transplant, and age. Data were collected on immunosuppression and rejection therapies, demographics, pre‐transplant viral status, number of rejections, and anti‐viral use. With adjustment for known risk factors, prophylactic anti‐viral use was associated with up to 83% reduction in the risk of PTLD, depending on the anti‐viral agent. These results were stronger for the first year post‐transplant. For every 30 days of ganciclovir treatment, risk of PTLD during the first year was lower by 38% (Odds Ratio [OR]= 0.62; 95% confidence interval [CI]= 0.38–1.0); acyclovir effects were less striking (OR = 0.83; 95% CI = 0.59–1.16). Anti‐viral therapy appears to play a role in reducing the risk of PTLD in renal transplant patients. Ganciclovir may be more potent than acyclovir.