Update on EBV Monitoring, Detection and Therapy in PTLD After Solid Organ Transplant

Abstract

EBV remains an important cause of morbidity and mortality in solid organ transplant (SOT) recipients. Post-transplant lymphoproliferative disorder is the most severe complication of EBV infection in SOT patients. While EBV viral load monitoring can be used to predict SOT patients at high risk of post-transplant lymphoproliferative disorder (most effectively for patients who are EBV seronegative prior to transplant), interpretation and management of these results may be confusing and can be complex. Monitoring to guide preemptive reduced immunosuppression has contributed to the decreased incidence of post-transplant lymphoproliferative disorder in SOT recipients. For the treatment of post-transplant lymphoproliferative disorder, increasing evidence supports the use of the anti-CD20 antibody rituximab. However, experience to date suggests that use of this agent may not prevent recurrence of tumor or improve cell-mediated immune responses to EBV. Future investigation of EBV-specific T-cell responses as an adjunct to monitoring and adoptive transfer of EBV-specific cytotoxic T lymphocytes appear likely in further attempts to limit the consequences of EBV infection in the SOT population.