The Immune Response to Epstein Barr Virus and Implications for Posttransplant Lymphoproliferative Disorder

Transplantation. 2017 Sep;101(9):2009-2016. doi: 10.1097/TP.0000000000001767.


Posttransplant lymphoproliferative disorder (PTLD) is a serious complication in organ transplant recipients and is most often associated with the Epstein Barr virus (EBV). EBV is a common gammaherpes virus with tropism for B lymphocytes and infection in immunocompetent individuals is typically asymptomatic and benign. However, infection in immunocompromised or immunosuppressed individuals can result in malignant B cell lymphoproliferations, such as PTLD. EBV+ PTLD can arise after primary EBV infection, or because of reactivation of a prior infection, and represents a leading malignancy in the transplant population. The incidence of EBV+ PTLD is variable depending on the organ transplanted and whether the recipient has preexisting immunity to EBV but can be as high as 20%. It is generally accepted that impaired immune function due to immunosuppression is a primary cause of EBV+ PTLD. In this overview, we review the EBV life cycle and discuss our current understanding of the immune response to EBV in healthy, immunocompetent individuals, in transplant recipients, and in PTLD patients. We review the strategies that EBV uses to subvert and evade host immunity and discuss the implications for the development of EBV+ PTLD.

Publication types

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

MeSH terms

  • Animals
  • Epstein-Barr Virus Infections / epidemiology
  • Epstein-Barr Virus Infections / immunology*
  • Epstein-Barr Virus Infections / virology
  • Herpesvirus 4, Human / growth & development
  • Herpesvirus 4, Human / immunology*
  • Herpesvirus 4, Human / pathogenicity
  • Host-Pathogen Interactions
  • Humans
  • Immunity, Humoral
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects*
  • Killer Cells, Natural / immunology
  • Killer Cells, Natural / virology
  • Lymphoproliferative Disorders / epidemiology
  • Lymphoproliferative Disorders / immunology*
  • Lymphoproliferative Disorders / virology
  • Opportunistic Infections / epidemiology
  • Opportunistic Infections / immunology*
  • Opportunistic Infections / virology
  • Organ Transplantation / adverse effects*
  • Organ Transplantation / methods
  • Risk Assessment
  • Risk Factors
  • T-Lymphocytes / immunology
  • T-Lymphocytes / virology
  • Treatment Outcome
  • Virus Replication


  • Immunosuppressive Agents