The Impact of EBV Status on Characteristics and Outcomes of Posttransplantation Lymphoproliferative Disorder

Am J Transplant. 2015 Oct;15(10):2665-73. doi: 10.1111/ajt.13324. Epub 2015 May 18.


We examined the associations of Epstein-Barr virus (EBV) status with characteristics and outcomes of posttransplantation lymphoproliferative disorder (PTLD) by studying 176 adult solid organ transplant recipients diagnosed with PTLD between 1990 and 2013 (58 [33%] EBV-negative; 118 [67%] EBV-positive). The proportion of EBV-negative cases increased over time from 10% (1990-1995) to 48% (2008-2013) (p < 0.001). EBV-negative PTLD had distinct characteristics (monomorphic histology, longer latency) though high-risk features (advanced stage, older age, high lactate dehydrogenase, central nervous system involvement) were not more common compared to EBV-positive PTLD. In multivariable analysis, EBV negativity was not significantly associated with worse response to initial therapy (adjusted odds ratio, 0.84; p = 0.75). The likelihood of achieving a complete remission (CR) was not significantly different for EBV-negative versus EBV-positive PTLD including when therapy was reduction of immunosuppression alone (35% vs. 43%, respectively, p = 0.60) or rituximab (43% vs. 47%, p = 1.0). EBV negativity was also not associated with worse overall survival (adjusted hazard ratio, 0.91; p = 0.71). Our findings indicate that EBV status is not prognostic or predictive of treatment response in adults with PTLD. The high proportion of EBV-negative disease diagnosed in recent years highlights the need for new strategies for prevention and management of EBV-negative PTLD.

Keywords: Infection and infectious agents; posttransplant lymphoproliferative disorder (PTLD); viral: Epstein-Barr Virus (EBV).

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Epstein-Barr Virus Infections / complications*
  • Epstein-Barr Virus Infections / diagnosis
  • Female
  • Humans
  • Infant
  • Lymphoproliferative Disorders / diagnosis
  • Lymphoproliferative Disorders / mortality
  • Lymphoproliferative Disorders / therapy
  • Lymphoproliferative Disorders / virology*
  • Male
  • Middle Aged
  • Organ Transplantation*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy
  • Postoperative Complications / virology*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Young Adult