Decreased Incidence of Early Onset PTLD in Pancreas Transplant Recipients After Initiating Universal IV/Oral Ganciclovir Prophylaxis

Abstract

699 We previously reported the development of early onset post-transplant lymphoproliferative disorder (PTLD) within 62 days of pancreas transplantation, associated with both a significantly higher total muromonab-CD3 (OKT3) dose and a lack of antiviral prophylaxis with IV ganciclovir. Because our data indicated that ganciclovir may help to prevent this potentially fatal disorder, in July 1996 we initiated a protocol using ganciclovir prophylaxis (5 mg/kg IV until oral intake, then 1000 mg PO TID for a total of 14 weeks) for all pancreas transplant recipients regardless of CMV serostatus. We now report the incidence of early onset PTLD in these patients and compare it to PTLD incidence in the earlier group (in which ganciclovir prophylaxis was given only to patients for which either the donor or recipient was positive for CMV). One hundred and thirty-one pancreas transplants were performed at our institution January 1, 1994 - June 30, 1996, and 90 were performed July 1, 1996 - September 30, 1997 (since the initiation of “universal” ganciclovir prophylaxis). All patients in both groups received a similar immunosuppressive regimen including OKT3 treatment for early rejection. The diagnosis of PTLD was confirmed by biopsy of lymph nodes or other involved organs, and positive staining of atypical lymphocytes for Epstein-Barr virus encoded RNA (EBER) and/or Epstein-Barr virus (EBV) late membrane protein-1. All 6 cases of PTLD in pancreas transplant recipients occurred in the 131 patients transplanted prior to July 1, 1996 (5 of whom had not received any ganciclovir prophylaxis), with none of the 90 patients given IV/oral ganciclovir developing this disorder (p =.04 by one-tailed Fisher's exact test). These data indicate that ganciclovir prophylaxis can prevent the development of early onset PTLD in pancreas transplant recipients.