Adapted treatment of Epstein-Barr virus infection to prevent posttransplant lymphoproliferative disorder after heart transplantation.
Up to 35% of posttransplant lymphoproliferative disorder (PTLD) cases occur within 1 year of transplantation, and over 50% are associated with Epstein-Barr virus (EBV). EBV primary infection and reactivation are PTLD predictive factors, but there is no consensus for their treatment. We conducted a prospective single-center study on 299 consecutive heart-transplant patients treated with the same immunosuppressive regimen and monitored by repetitive EBV viral-load measurements and endomyocardial biopsies to detect graft rejection. Immunosuppression was tapered on EBV reactivation with EBV viral loads >10(5) copies/mL or primary infection. In the absence of response at 1 month or a viral load >10(6) copies/mL, patients received one rituximab infusion (375 mg/m(2) ). All patients responded to treatment without increased graft rejection. One primary infection case developed a possible PTLD, which completely responded to diminution of immunosuppression, and one patient, whose EBV load was unevaluable, died of respiratory complications secondary to PTLD. Compared with a historical cohort of 820 patients, PTLD incidence was decreased (p = 0.033) by a per-protocol analysis. This is the largest study on EBV primary infection/reactivation treatment, the first using rituximab following solid organ transplantation to prevent PTLD and the first to demonstrate an acceptable tolerability profile in this setting.
['Choquet|S|S|', 'Varnous|S|S|', 'Deback|C|C|', 'Golmard|J L|JL|', 'Leblond|V|V|']
D000293:Adolescent D000328:Adult D000368:Aged D004279:DNA, Viral D020031:Epstein-Barr Virus Infections D005260:Female D005500:Follow-Up Studies D006084:Graft Rejection D016027:Heart Transplantation D004854:Herpesvirus 4, Human D006801:Humans D007166:Immunosuppressive Agents D008232:Lymphoproliferative Disorders D008297:Male D008875:Middle Aged D016133:Polymerase Chain Reaction D011183:Postoperative Complications D011379:Prognosis D011446:Prospective Studies D012307:Risk Factors D019562:Viral Load D014775:Virus Activation D055815:Young Adult
Epstein-Barr virus heart transplantation immunosuppression rituximab posttransplantation lymphoproliferative disease