Lazda V A
Gift of Hope Organ & Tissue Donor Network, Histocompatibility Laboratory, Elmhurst, Illinois 60126-1520, USA.
Transplant Proc. 2006 Dec;38(10):3404-5. doi: 10.1016/j.transproceed.2006.10.066.
Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication following organ transplantation. The greatest risk is seen in Epstein-Barr virus (EBV)-seronegative patients receiving allografts from EBV-seropositive donors. The severity and frequency of PTLD are particular concerns for pediatric patients, who frequently are EBV negative and hence more likely to be EBV infected from an EBV-positive organ donor. The aim of this study was to analyze the EBV serostatus of deceased organ donors and to assess the likelihood of recipient/donor matching for EBV serostatus.
Sera obtained from local deceased organ donors for the period 2004-2005 were retrospectively tested for EBV viral capsid antigen (VCA) IgG and IgM antibodies by an enzyme-linked immunosorbent assay (ELISA). The analysis included only data from those donors who were tested using a pretransfusion specimen (n = 459). The influence of various factors on the EBV serostatus of the donor was assessed, including age, gender, ethnicity, and cytomegalovirus (CMV) serostatus of the donor.
Overall, only 27 (6%) of the 459 donors were EBV seronegative, with 94% being positive for IgG antibodies to EBV. A higher percentage of the EBV-seronegative donors were younger donors (age < or =35 years), compared with EBV-seropositive donors, 74% (n = 27) vs 31% (n = 432), P < .0001. A higher percentage (85%) of the younger (age < or =35 years) EBV-seronegative donors (n = 20) were also CMV seronegative. There was also a greater likelihood for the younger (age < or =35 years) CMV-seronegative donors to be EBV seronegative, compared with the older (age >35 years) CMV-seronegative donors, 20% (n = 83) vs 1% (n = 93), P < .0001. There was no influence of other factors examined on EBV serostatus.
EBV-seronegative organ donors are infrequent and therefore provide only a limited supply of organs for patients in need of them. The higher frequency of EBV-seronegative donors being the younger donors will benefit the pediatric patients who have the greatest need for an EBV serostatus matched organ from a younger donor. Recent policy changes at the United Network for Organ Sharing (UNOS) giving priority to pediatric patients for kidneys from younger donors (age < or =35 years) and prospective EBV testing of donors will be helpful in the appropriate allocation of these organs.
移植后淋巴细胞增生性疾病（PTLD）是器官移植后一种危及生命的并发症。在接受来自EB病毒（EBV）血清学阳性供体的同种异体移植物的EBV血清学阴性患者中，风险最大。PTLD的严重程度和发生率是儿科患者特别关注的问题，儿科患者通常EBV阴性，因此更有可能从EBV阳性器官供体感染EBV。本研究的目的是分析已故器官供体的EBV血清学状态，并评估受者/供体EBV血清学状态匹配的可能性。
回顾性检测2004 - 2005年期间从当地已故器官供体获得的血清中EBV病毒衣壳抗原（VCA）IgG和IgM抗体，采用酶联免疫吸附测定（ELISA）法。分析仅包括那些使用输血前标本检测的供体的数据（n = 459）。评估了各种因素对供体EBV血清学状态的影响，包括供体的年龄、性别、种族和巨细胞病毒（CMV）血清学状态。
总体而言，459名供体中仅27名（6%）为EBV血清学阴性，94%的供体EBV IgG抗体呈阳性。与EBV血清学阳性供体相比，EBV血清学阴性供体中年轻供体（年龄≤35岁）的比例更高，分别为74%（n = 27）和31%（n = 432），P <.0001。年龄≤35岁的年轻EBV血清学阴性供体（n = 20）中，更高比例（85%）的供体CMV血清学也为阴性。与年龄>35岁的CMV血清学阴性供体相比，年龄≤35岁的CMV血清学阴性供体更有可能EBV血清学阴性，分别为20%（n = 83）和1%（n = 93），P <.0001。所检测的其他因素对EBV血清学状态无影响。
EBV血清学阴性器官供体很少见，因此只为有需要的患者提供有限的器官供应。EBV血清学阴性供体中年轻供体比例较高，这将使最需要从年轻供体获得EBV血清学匹配器官的儿科患者受益。器官共享联合网络（UNOS）最近的政策变化优先考虑儿科患者接受来自年轻供体（年龄≤35岁）的肾脏，并对供体进行前瞻性EBV检测，这将有助于这些器官的合理分配。
