Does CMV Mismatch Status Modify the Risk of PTLD Due to EBV Mismatch Status in Lung and Heart Transplant Recipients?

Abstract

Purpose Epstein-Barr virus (EBV) mismatch is a known risk factor for posttransplant lymphoproliferative disorders (PTLD) in lung and heart transplant recipients (LTx and HTx). We evaluated the potential modifying effect of cytomegalovirus (CMV) mismatch on the relation between EBV mismatch and PTLD in LTx and HTx. Methods and Materials We performed a study of U.S. LTx and HTx recipients from 2000-2011 in the Scientific Registry of Transplant Recipient (SRTR). Adjustment for sextiles of the propensity score (based on the probability of being an EBV mismatch) was used to account for confounding in Cox proportional hazards models stratified for organ type. Results The study population included 5957 LTx (61 PTLDs; 1.02%) and 7870 HTx (39 PTLDs; 0.5%) with complete data on CMV and EBV serostatus. A total of 272 LTx and 457 HTx were concurrently CMV and EBV mismatches. After adjustment for sextiles of the propensity score, the hazard ratio (HR) for PTLD was 4.4 (95% CI: 2.9-6.7) and 1.6 (95% CI: 1.1-2.5) in EBV and CMV mismatch recipients, respectively. When compared to patients who were neither CMV nor EBV mismatch, the adjusted HR for PTLD in patients who were CMV mismatch only, EBV mismatch only, and both CMV/EBV mismatch were 1.8 (95% CI: 1.1-3.3), 4.8 (95% CI: 2.9-8.1), and 7.0 (95% CI: 3.9-12.7), respectively. However, the HRs for the association of EBV mismatches and PTLD in CMV mismatch and non-mismatch patients did not significantly differ (P value for interaction=0.6). [ figure 1 ] Conclusions EBV mismatch status is significantly associated with risk for PTLD in LTx and HTx. Concomitant CMV mismatch status in EBV mismatch patients does not significantly modify the relative hazard of PTLD.