The Association of Epstein-Barr Virus Donor and Recipient Serostatus With Outcomes After Kidney Transplantation : A Retrospective Cohort Study.

IF 15.2 1区医学 Q1 MEDICINE, GENERAL & INTERNAL Annals of Internal Medicine Pub Date : 2025-02-01 Epub Date: 2025-01-28 DOI:10.7326/ANNALS-24-00165

Vishnu S Potluri, Siqi Zhang, Douglas E Schaubel, Salma Shaikhouni, Emily A Blumberg, Sunita D Nasta, Roy D Bloom, Massiel Cruz-Peralta, Rajil B Mehta, Nikhil R Lavu, Bereket Getachew, Srijan Tandukar, Peter P Reese, Chethan M Puttarajappa

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Abstract

Background: Prior studies indicate that 1% to 4% of Epstein-Barr virus (EBV)-seronegative recipients of EBV-seropositive donor (EBV D+/R-) kidneys develop posttransplant lymphoproliferative disorder (PTLD). However, these estimates are based on limited data that lack granularity.

Objective: To determine the associations between pretransplant EBV D+/R- and recipient EBV-seropositive status (R+) and the outcomes of PTLD and graft and patient survival among adult kidney transplant recipients.

Design: Retrospective cohort study.

Setting: Two large U.S. transplant centers.

Participants: Epstein-Barr virus D+/R- and EBV R+ recipients matched 1:3 on donor, recipient, and transplant characteristics between 1 January 2010 and 30 June 2022.

Measurements: Exposure was pretransplant donor and recipient EBV serostatus. The primary outcome was biopsy-proven PTLD. Secondary outcomes were all-cause graft loss (death, retransplant, or graft failure) and death. Follow-up was truncated to 3 years after transplant.

Results: The final cohort comprised 104 EBV D+/R- recipients matched to 312 EBV R+ recipients. The mean age was 42 years (SD, 17.1), 59% were living donor transplants, and 95% received thymoglobulin induction. Among EBV D+/R- recipients, 50 (48.1%) developed EBV DNAemia, with a median time of 198 days (IQR, 110 to 282 days) after transplantation. Posttransplant lymphoproliferative disorder occurred in 23 (22.1%) EBV D+/R- recipients at a median of 202 days (IQR, 118 to 317 days) after transplantation. Epstein-Barr virus D+/R- recipients had higher all-cause graft failure (hazard ratio, 2.21 [95% CI, 1.06 to 4.63]); mortality was higher but not statistically significant (hazard ratio, 2.19 [CI, 0.94 to 5.13]).

Limitation: Two-center study.

Conclusion: Compared with previous studies, this study showed that EBV D+/R- kidney recipients face a 5- to 10-fold higher cumulative incidence of PTLD. Strategies to mitigate the PTLD risk are urgently needed.

Primary funding source: National Institutes of Health.

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Epstein-Barr病毒供体和受体血清状态与肾移植后预后的关系：一项回顾性队列研究

背景：先前的研究表明，EBV血清阳性供体（EBV D+/R-）肾脏的1% - 4% EBV血清阴性受体发生移植后淋巴细胞增生性疾病（PTLD）。然而，这些估计是基于缺乏粒度的有限数据。目的：探讨成人肾移植受者移植前EBV D+/R-和受体EBV血清阳性状态（R+）与PTLD和移植物结局及患者生存的关系。设计：回顾性队列研究。环境：美国两个大型移植中心。参与者：2010年1月1日至2022年6月30日期间，Epstein-Barr病毒D+/R-和EBV R+受体在供体、受体和移植特征上匹配1:3。测量：暴露于移植前供体和受体的EBV血清状态。主要结果是活检证实的PTLD。次要结局是全因移植物损失（死亡、再移植或移植物衰竭）和死亡。随访时间缩短至移植后3年。结果：最终队列包括104名EBV D+/R-受体与312名EBV R+受体配对。平均年龄42岁（SD, 17.1）， 59%为活体供体移植，95%接受胸腺球蛋白诱导。在EBV D+/R-受体中，50例（48.1%）发生EBV dna血症，移植后中位时间为198天（IQR， 110 ~ 282天）。23例（22.1%）EBV D+/R-受体在移植后中位202天（IQR， 118 ~ 317天）发生移植后淋巴细胞增生性疾病。Epstein-Barr病毒D+/R-受体受体的全因移植物衰竭发生率较高（风险比2.21 [95% CI, 1.06 ~ 4.63]）；死亡率较高，但无统计学意义（风险比2.19 [CI, 0.94 ~ 5.13]）。局限性：双中心研究。结论：与以往的研究相比，本研究显示EBV D+/R-肾受体PTLD的累积发病率高出5- 10倍。迫切需要减轻PTLD风险的战略。主要资金来源：美国国立卫生研究院。

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来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.