Prevention and Treatment of EBV-Related Complications

Abstract

EBV is a potentially important pathogen in children and adults undergoing solid organ transplantation. EBV most frequently causes clinical disease in the setting of an EBV-seronegative recipient with the most likely source of infection being an EBV-seropositive donor. Primary EBV infection can be associated with a spectrum of clinical manifestations ranging from asymptomatic infection, a non-specific febrile syndrome that resembles the so-called CMV syndrome, mononucleosis, and posttransplant lymphoproliferative disorders (PTLD) including lymphoma. While EBV is similar to other members of the Herpesviridae family in its ability to cause both latent and lytic infection, its ability to transform and immortalize infected B cells explains its progression to PTLD. The primary risk factor for symptomatic EBV disease is acquisition of primary EBV infection though disease frequency varies by the organ transplanted, intensity and type of immunosuppression, and to a lesser extent the age of the recipient. Diagnosis of EBV disease can be suspected by the presence of compatible clinical symptoms but is confirmed by the presence of both an elevated EBV load in the peripheral blood and histologic confirmation of tissue involvement by EBV. Because current antiviral agents such as acyclovir or ganciclovir do not impact EBV-driven lymphoproliferation of transformed B lymphocytes, both prevention and treatment strategies differ from the approach taken to other herpes viruses. The range of interventions frequently includes reduction or withdrawal of immunosuppression but may also require chemotherapy for the treatment of EBV-associated lymphoma. This chapter will review the epidemiology, diagnosis, prevention, and treatment of EBV disease and PTLD.