Clinical transplantation 2017 05 10() doi 10.1111/ctr.13000
EBV D+/R- organ transplant recipients are a high-risk group for developing PTLD. Little data are available for prevention in the adult EBV mismatched population. We conducted a retrospective study of EBV D+/R- organ transplants performed during 2002-2014. Of the 153 patients identified, 82.4% patients received antiviral prophylaxis with valganciclovir for a median of 4.5 months (range 0.8-22 months) and 36.6% underwent viral load monitoring in the first post-transplant year. EBV viremia developed in 67.2% monitored patients. In viremic patients, immunosuppression was reduced in 20/37(54.1%) in response to viremia and 17/37(45.9%) received therapeutic dose valganciclovir. In patients with EBV viremia who received valganciclovir and/or had a reduction in immunosuppression and had sufficient viral load time points (n=31), 28(90.3%) had a significant decline in viral load at day 14 (median log decline 0.49(0.24-0.64), p<0.001) and at day 30 (0.87(0.52-1.21), p<0.001). PTLD developed in 27(15%) patients (biopsy proven=25, possible=2) at median 8 months (range 2.4-130) post-transplant with the majority (81.5%) within the first year. In multivariate analysis, viral load monitoring and use of mycophenolate were associated with a lower incidence of PTLD. Antiviral prophylaxis was not associated with a lower risk of PTLD but viral load monitoring and use of MMF were protective. This article is protected by copyright. All rights reserved.