Thomas Schachtner1,2, Petra Reinke1,2. 1. Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany. 2. Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
Abstract
BACKGROUND: Because of the strikingly increased risk of post-transplant lymphoproliferative disorder (PTLD) in Epstein-Barr virus (EBV)-seronegative kidney transplant recipients (KTRs) from EBV-seropositive donors-EBV(D+ R- ), special strategies need to be defined to prevent EBV transmission and EBV viremia. METHODS: We studied all KTRs at our center between 2008 and 2012. Seventeen of 402 KTRs (4.2%) were identified as EBV(D+ R- ), among which 5 KTRs received kidneys from living donors and 12 KTRs from deceased donors. KTRs undergoing living donation were treated with a single dose of rituximab 4 weeks prior to transplantation. Assessment of EBV seroconversion and EBV viremia was performed. RESULTS: Among 12 EBV-seronegative KTRs from deceased donors, all 12 KTRs (100%) showed EBV seroconversion, 7 KTRs (58%) showed active EBV viremia, and 1 KTR (8%) developed PTLD. In comparison, 3 of 5 KTRs from living donors, who received pretransplant rituximab, remained EBV-seronegative post transplantation, and no KTR developed EBV viremia (P<.05). All KTRs who received pretransplant rituximab showed excellent allograft function, with no increase in infections or malignancies. CONCLUSIONS: Our data suggest that rituximab-mediated elimination of B cells may prevent transmission of EBV to the recipient, as EBV persistence requires the establishment of a latent infection in recipient B cells. Pretransplant rituximab may prove useful to prevent primary EBV infection in EBV-seronegative KTRs.
BACKGROUND: Because of the strikingly increased risk of post-transplant lymphoproliferative disorder (PTLD) in Epstein-Barr virus (EBV)-seronegative kidney transplant recipients (KTRs) from EBV-seropositive donors-EBV(D+ R- ), special strategies need to be defined to prevent EBV transmission and EBV viremia. METHODS: We studied all KTRs at our center between 2008 and 2012. Seventeen of 402 KTRs (4.2%) were identified as EBV(D+ R- ), among which 5 KTRs received kidneys from living donors and 12 KTRs from deceased donors. KTRs undergoing living donation were treated with a single dose of rituximab 4 weeks prior to transplantation. Assessment of EBV seroconversion and EBV viremia was performed. RESULTS: Among 12 EBV-seronegative KTRs from deceased donors, all 12 KTRs (100%) showed EBV seroconversion, 7 KTRs (58%) showed active EBV viremia, and 1 KTR (8%) developed PTLD. In comparison, 3 of 5 KTRs from living donors, who received pretransplant rituximab, remained EBV-seronegative post transplantation, and no KTR developed EBV viremia (P<.05). All KTRs who received pretransplant rituximab showed excellent allograft function, with no increase in infections or malignancies. CONCLUSIONS: Our data suggest that rituximab-mediated elimination of B cells may prevent transmission of EBV to the recipient, as EBV persistence requires the establishment of a latent infection in recipient B cells. Pretransplant rituximab may prove useful to prevent primary EBVinfection in EBV-seronegative KTRs.
Authors: Mieko Toyoda; Bong-Ha Shin; Shili Ge; James Mirocha; David Thomas; Maggie Chu; Edgar Rodriguez; Christine Chao; Anna Petrosyan; Odette A Galera; Ashley Vo; Jua Choi; Alice Peng; Joseph Kahwaji; Stanley C Jordan Journal: J Immunol Res Date: 2017-02-06 Impact factor: 4.818