Detection of Epstein-Barr virus DNAemia after lung transplantation and its potential relationship with the development of post-transplant complications

作者：Silva J T; Lopez Medrano F^*; Alonso Moralejo R; Fernandez Ruiz M; de Pablo Gafas A; Perez Gonzalez V; San Juan R; Perez Jacoiste Asin M A; Ruiz Merlo T; Folgueira M D; Aguado J M

来源：Transplant Infectious Disease, 2016, 18(3): 431-441.

DOI：10.1111/tid.12541

• lung transplantation
• Epstein-Barr virus
• opportunistic infection
• bronchiolitis obliterans syndrome
• immunosuppression

BackgroundRecent studies suggest that Epstein-Barr virus DNAemia (EBVd) may act as a surrogate marker of post-transplant immunosuppression. This hypothesis has not been tested so far in lung transplant (LT) recipients.
MethodsWe included 63 patients undergoing lung transplantation at our center between October 2008 and May 2013. Whole blood EBVd was systematically assessed by real-time polymerase chain reaction assay on a quarterly basis. The occurrence of late complications (overall and opportunistic infection [OI] and chronic lung allograft dysfunction [CLAD]) was analyzed according to the detection of EBVd within the first 6 months post transplantation.
ResultsAny EBVd was detected in 30 (47.6%) patients. Peak EBVd was higher in patients with late overall infection (2.23 vs. 1.73 log(10) copies/mL; P = 0.026) and late OI (2.39 vs. 1.74 log(10) copies/mL; P = 0.004). The areas under receiver operating characteristic curves for predicting both events were 0.806 and 0.871 respectively. The presence of an EBVd 2 log(10) copies/mL during the first 6 months post transplantation was associated with a higher risk of late OI (adjusted hazard ratio [aHR] 7.92; 95% confidence interval [CI] 2.10-29.85; P = 0.002). Patients with detectable EBVd during the first 6 months also had lower CLAD-free survival (P = 0.035), although this association did not remain statistically significant in the multivariate analysis (aHR 1.26; 95% CI 0.87-5.29; P = 0.099).
ConclusionsAlthough preliminary in nature, our results suggest that the detection of EBVd within the first 6 months after transplantation is associated with the subsequent occurrence of late OI in LT recipients.

• 出版日期2016-6