Monitoring Epstein-Barr viral load after liver transplant may reduce risk for rare posttransplant complication

A study of adult recipients of liver transplants has found that monitoring transplant recipients for Epstein-Barr virus viral load (EBV VL) helped to reduce risk for posttransplant lymphoproliferative disease (PTLD), a rare but serious potential complication of transplantation.

The findings are published in Annals of Internal Medicine.

Primary infection with or reactivation of EBV can occur after liver transplant and can lead to PTLD. An EBV VL monitoring strategy, including the reduction of immunosuppression is hypothesized to reduce incidence of PTLD in adult transplant recipients -almost all IgG anti-EBV positive).

Researchers from the Transplantation Centers of Leiden University Medical Center and Erasmus Medical Center, The Netherlands studied health records for adult recipients of first liver transplant at these two university medical centers in Leiden and Rotterdam to examine the effect of an EBV VL monitoring strategy on the incidence of PTLD during long-term follow-up after liver transplant in adults. The researchers conducted a difference-in-difference analysis among 4 groups. Adult recipients of first liver transplant in Leiden between September 2003 and January 2017 with an EBV VL monitoring strategy formed the monitoring group; recipients of first liver transplant in Rotterdam between January 2003 and January 2017 without such a strategy formed the contemporary control group; and those who had transplants in Leiden between September 1992 and September 2003 or Rotterdam between 1986 and January 2003 formed the historical control groups.

The analysis showed a numerically larger within-hospital decrease in PTLD in Leiden-with EBV VL monitoring strategy in the contemporary cohort-over time than in Rotterdam-without EBV VL monitoring strategy. According to the authors, these findings suggest that an EBV VL monitoring policy -with reduction of immunosuppression in case of EBV VL detection- should be considered in transplant programs to avoid over-immunosuppression and thereby reduce the incidence of PTLD.

Reference:

Bastian N. Ruijter, Ron Wolterbeek, Mitchell Hew,  Marjolein van Reeven, Danny van der Helm, Jeroen Dubbeld, Maarten E. Tushuizen, Herold Metselaar, Ann C.T.M. Vossen, and Bart van Hoek, https://doi.org/10.7326/M22-0364