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Epstein-Barr virus infection after kidney transplantation

Abstract

Besides the well-known association of Epstein-Barr virus (EBV) and lymphomas developing posttransplantation, there are only a few data concerning the prevalence of EBV antibodies (abs) in organ donors and recipients, the posttransplant development of antibody titer in the recipient population, the extent of EBV-IgM seroconversion, and the clinical and laboratory signs associated with infection. Therefore, in a retrospective analysis, we evaluated the data of 119 organ donors and 215 kidney graft recipients who received their kidney allografts between 1993 and 1995. A total of 665 sera were quantitatively tested by means of immunofluorescence assay for EBV abs against capsid (CA; IgM, IgG), early (IgG), and nuclear (IgG) antigens. Recipient sera were obtained for testing before kidney transplantation (KTx) and at post-KTx days 32, 67, and 649 (mean values). Pre-KTx all organ donors and 98.65 % of the recipients were EBV-CA-IgG positive, only in two cases was there a D+/R (donor/recipient) combination leading to primary EBV infection. In comparison with the organ donors, in kidney graft recipients the pre-KTx IgG antibody titers (geometric mean) against EBV-CA were significantly elevated (1 : 428 vs 1 : 574; U-test). Post-KTx, EBV-CA-IgM seroconversion was observed in 29.5 % (52 out of 176) of first graft recipients and in 47.8 % (11 out of 23) of regrafted patients up to the last follow-up day 649. In 219 out of these 52 recipients, IgM abs again cytomegalovirus (CMV) could also be detected; the other 23 did not develop CMV-IgM abs. The most frequently associated clinical signs were fever (74 %), elevated aminotransferases (57 %), and deterioration of graft function (26 %). In the EBV-IgM+/CMV-IgM+ group there were significantly more rejection therapies than in the EBV-IgM+/CMV-IgM group. With respect to the severity of EBV infections, 68 % were asymptomatic or mild, 27 % moderate, and 4 % (only 1) severe. Thus, besides the post-KTx CMV monitoring, EBV monitoring should also belong to the follow-up checks.

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Kaden, J., Petersen, S., Kaden, K. et al. Epstein-Barr virus infection after kidney transplantation. Transpl Int 11, S119–S124 (1998). https://doi.org/10.1007/s001470050442

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  • Key words Epstein-Barr virus
  • Kidney transplantation
  • Infection
  • Rejection