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Transplant Infections pp 477–512Cite as

Epstein–Barr Virus Infection and Lymphoproliferative Disorders After Transplantation

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Abstract

Epstein–Barr virus (EBV) infection is highly prevalent in both transplant recipients and donors and plays an important role in the pathogenesis of most cases of posttransplant lymphoproliferative disorder (PTLD) seen early after transplant. Over the past decade an epidemiologic shift in PTLD incidence has occurred: PTLD occurring early posttransplant predominantly in high-risk recipients has decreased. This improvement has been attributed to preemptive prevention strategies in these patients and evolving immunosuppression regimens. Efforts have also been made to standardize assays measuring EBV viral load with the goal of improving inter-assay comparisons and standardizing practices. However, EBV-negative PTLD occurring late posttransplant is now emerging as the predominant PTLD subtype, particularly in solid organ transplant recipients. Further research efforts focused on the epidemiology, pathogenesis, and treatment of late PTLDs are required. A prospective, multicenter, controlled trial evaluating sequential therapy with the anti-CD20 monoclonal antibody rituximab followed by chemotherapy has demonstrated prolonged remissions with improved tolerability. But, given the lack of other comparable studies, the standard of care for treatment of PTLD cannot be established. Future therapeutic trials are needed to identify patients that can be spared from chemotherapy, and novel therapeutic approaches must be explored to prevent disease, improve outcomes, and expand the therapeutic armamentarium.

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Authors and Affiliations

  1. Division of Infectious Diseases,Department of Medicine, University of Alberta, CSB1-125, 11350 83 Avenue, Edmonton, AB, Canada, T6G 2G3

    Jutta K. Preiksaitis B.Sc., M.D., F.R.C.P.(C)

  2. Division of Nephrology, Department of Medicine, University of Alberta, CSB 1-139E, 11350 83 Avenue NW, Edmonton, AB, Canada, T6G 2G3

    Sandra M. Cockfield M.D.

  3. Division of Hematology, Department of Medicine, University of Alberta, CSB 4-112E, 11350 83 Avenue NW, Edmonton, AB, Canada, T6G 2G3

    Anthea C. Peters M.D., M.Sc., F.R.C.P.C.

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  1. Jutta K. Preiksaitis B.Sc., M.D., F.R.C.P.(C)
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  2. Sandra M. Cockfield M.D.
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  3. Anthea C. Peters M.D., M.Sc., F.R.C.P.C.
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Correspondence to Jutta K. Preiksaitis B.Sc., M.D., F.R.C.P.(C) .

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  1. Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Per Ljungman

  2. Tufts University School of Medicine Tufts Medical Center, Boston, MA, USA

    David Snydman

  3. University of Washington Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Michael Boeckh

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Preiksaitis, J.K., Cockfield, S.M., Peters, A.C. (2016). Epstein–Barr Virus Infection and Lymphoproliferative Disorders After Transplantation. In: Ljungman, P., Snydman, D., Boeckh, M. (eds) Transplant Infections. Springer, Cham. https://doi.org/10.1007/978-3-319-28797-3_26

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