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Epstein‐Barr virus infection after kidney transplantation

Abstract Besides the well‐known association of Epstein‐Barr virus (EBV) and lymphomas developing posttransplantation, there are only a few data concerning the prevalence of EBV antibodies (abs) in organ donors and recipients, the post‐transplant development of antibody titer in the recipient population, the extent of EBV‐IgM seroconversion, and the clinical and laboratory signs associated with infection. Therefore, in a retrospective analysis, we evaluated the data of 119 organ donors and 215 kidney graft recipients who received their kidney allografts between 1993 and 1995. A total of 665 sera were quantitatively tested by means of immunofluorescence assay for EBV abs against capsid (CA; IgM, IgG), early (IgG), and nuclear (IgG) antigens. Recipient sera were obtained for testing before kidney transplantation (KTx) and at post‐KTx days 32, 67, and 649 (mean values). Pre‐KTx all organ donors and 98.65 % of the recipients were EBV‐CA‐IgG positive, only in two cases was there a D+/R‐ (donor/recipient) combination leading to primary EBV infection. In comparison with the organ donors, in kidney graft recipients the pre‐KTx IgG antibody titers (geometric mean) against EBV‐CA were significantly elevated (1: 428 vs 1: 574; U‐test). Post‐KTx, EBV‐CA‐IgM seroconversion was observed in 29.5 % (52 out of 176) of first graft recipients and in 47.8% (11 out of 23) of re grafted patients up to the last follow‐up day 649. In 219 out of these 52 recipients, IgM abs again cytomegalovirus (CMV) could also be detected; the other 23 did not develop CMV‐IgM abs. The most frequently associated clinical signs were fever (74%), elevated aminotransferases (57%), and deterioration of graft function (26 %). In the EBV‐IgM+/CMV‐IgM+ group there were significantly more rejection therapies than in the EBV‐IgM+/CMV‐IgM‐ group. With respect to the severity of EBV infections, 68% were asymptomatic or mild, 27 % moderate, and 4% (only 1) severe. Thus, besides the post‐KTx CMV monitoring, EBV monitoring should also belong to the follow‐up checks.