Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey

R. San-Juan, O. Manuel, H. H. Hirsch, M. Fernández-Ruiz, F. López-Medrano, P. Comoli, S. Caillard, P. Grossi, J. M. Aguado, Jose Maria Alamo-Martinez, Fernando Anaya, Veli Jukka Anttila, Miha Arnol, Alfonso W. Avolio, Umberto Baccarani, Isabel Beneyto Castello, Ioannis Boletis, Renzo Bonofiglio, Celine Bressollette, Jens BrockmannSophie Caillard, Jorge Calvo Pulido, Pilar Catalan, Claus Christiansen, Frederic Cofan, Elisa Cordero, Marisa Crespo Leiro, Jacques Dantal, Andrea D'armini, Juan F. Delgado, Luca Dello Strologo, Francesco Di Raimondo, Daan Dierickx, Anna Eis-Hübinger, Samira Faf Kremer, Giuseppe Faggian, Maria Carmen Farinas, Maria Dolores Folgueira, Iris Fontana, Antonio Franco, Lucrezia Furian, Christian Garzoni, Giulia Ghirardo, Fabrizio Ginevri, Josep Grinyo, Paolo Antonio Grossi, Girish Gupte, Lennart Hansson, Ilkka Helantera, Jose Ignacio Herrero, Hans H. Hirsch, David Hobin, Dieter Hoffmann, Lerut Jan, Isidro Jarque, Bente Jespersen, Ingo Kaczmarek, Pilarczyk Kevin, Irene Koneth, Damjan Kovac, Florence Lacaille, Irmeli Lautenschlager, Oscar Len, Laura Llado, Monica Loy, Oriol Manuel, Maria Angeles Marcos Maeso, Leruez Ville Marianne, James Marsh, Pascal Meylan, Eduardo Minambres, Miguel Montejo, Nicolas Mueller, Patricia Munoz, Silvio Nadalin, Nassim Kamar, Blin Nicolas, Detry Olivier, Jesus Palomo, Manuel Pascual, Jaksch Peter, Frange Pierre, M. Francisca Portero, Francois Provot, Esther Ramos Boluda, Enrico Regalia, Gabriel Reina, Stefan Reuter, Jose Ricart, Minerva Rodriguez Garcia, Halvor Rollag, Francesco Paolo Russo, Nuria Sabe, Magdalena Salcedo, Luigi Santambrogio, Tomas Seeman, Nuria Serra, Dino Sgarabotto, Jan Simonek, Yandza Thierry, Marianne Kragh Thomsen, Nijaz Tihic, Julian Torre-Cisneros, Giovanna Travi, Patrizia Tulissi, Valerie Moal, Massimiliano Veroux, Ana Vila Santandreu, Giovanni Vizzini, Lada Zibar

Research output: Contribution to journalArticle

Abstract

There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients.

Original languageEnglish
Pages (from-to)604.e1-604.e9
JournalClinical Microbiology and Infection
Volume21
Issue number6
DOIs
Publication statusPublished - Jun 1 2015

Keywords

  • Epstein-Barr virus
  • Europe
  • Post-transplant lymphoproliferative disease
  • Pre-emptive treatment
  • Survey

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    San-Juan, R., Manuel, O., Hirsch, H. H., Fernández-Ruiz, M., López-Medrano, F., Comoli, P., Caillard, S., Grossi, P., Aguado, J. M., Alamo-Martinez, J. M., Anaya, F., Anttila, V. J., Arnol, M., Avolio, A. W., Baccarani, U., Castello, I. B., Boletis, I., Bonofiglio, R., Bressollette, C., ... Zibar, L. (2015). Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey. Clinical Microbiology and Infection, 21(6), 604.e1-604.e9. https://doi.org/10.1016/j.cmi.2015.02.002