Characteristics of Epstein-Barr viraemia in adult liver transplant patients: a retrospective cohort study.

Abstract

Therapeutic immunosuppression following solid organ transplantation increases the risk of Epstein-Barr (EBV) viraemia, which is implicated in post-transplant lymphoproliferative disease (PTLD). We retrospectively analysed the incidence of EBV viraemia and clinical outcomes in 98 liver transplant recipients. Patients underwent EBV DNA monitoring by whole-blood PCR: EBV levels were correlated with clinical parameters and outcomes for a median of 249days. 67% patients developed EBV viraemia (EBV DNA ≥100 copies/ml) and 30% had sustained viraemia. There was a trend towards higher hazard ratios for viraemia with exposure to aciclovir (HR 1.57, P=0.12) or in recipients of a poorly HLA-matched graft (HR 1.62, P=0.10). These associations became significant in the subgroup with >90days surveillance; HR 2.54 (P=0.0015) for aciclovir and HR 1.99 (P=0.03) for poorly matched grafts. The converse was true with ganciclovir (HR 0.56 P=0.13). Viraemia was more prolonged in men (median duration 7days vs 1; P=0.01) and in those with lower UKELD scores (11days vs 1day; P=0.001) but shortened with ganciclovir exposure (P=0.06). Younger patients were more likely to have high peak viral loads (P=0.07). No clinical signs or symptoms or adverse outcomes were associated with EBV reactivation.