Mah Jordan K, Tam Patrick C K, Chang Yeh-Chung, Saullo Jennifer H, Baker Arthur W, Maziarz Eileen K, Messina Julia A, Sim Beatrice, Abusalem Lana, Hanna Sandrine, Pipeling Matthew R, Snyder Laurie D, Reynolds John M, Wolfe Cameron R, Lee Mark J, Alexander Barbara D, Heldman Madeleine R
Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA.
Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA.
J Clin Virol. 2025 Feb;176:105758. doi: 10.1016/j.jcv.2024.105758. Epub 2024 Dec 13.
EBV DNAemia surveillance, with reduction of immunosuppression at certain viral load (VL) thresholds, is a common practice for mitigating progression from EBV DNAemia to post-transplant lymphoproliferative disorder (PTLD) in lung transplant recipients (LTRs). The utility of EBV surveillance in adult EBV seropositive LTRs is unknown.
We performed a retrospective cohort study of EBV seropositive adult LTRs who underwent lung transplant between 1/1/19 and 12/31/20 and received whole blood (WB) EBV PCR surveillance. We compared peak WB EBV VLs among 3 groups: 1) asymptomatic LTRs who developed PTLD, before PTLD was clinically suspected, 2) LTRs who developed PTLD, after PTLD was clinically suspected, and 3) LTRs who did not develop PTLD. We calculated the positive predictive value (PPV) of moderate-grade DNAemia (2840 to 11,360 IU/mL) and high-grade DNAemia (≥ 11,360 IU/mL) for identifying active or future PTLD.
Six (2.6 %) of 229 LTRs developed PTLD. Among LTRs who developed PTLD, median peak EBV VL was significantly higher after PTLD was suspected than before clinical signs of PTLD were present (16,004 IU/mL vs. ≤568 IU/mL, p = 0.016). Median peak EBV VLs were similar between asymptomatic LTRs who later developed PTLD and LTRs who did not develop PTLD (median peak EBV VL ≤568 IU/mL vs. ≤568 IU/mL, p = 0.62). The PPVs for moderate- and high-grade DNAemia were 14.7 % and 33.3 %, respectively.
EBV surveillance did not accurately identify EBV seropositive LTRs at risk for progressing to PTLD. EBV PCR testing in asymptomatic EBV seropositive transplant recipients may represent an opportunity for diagnostic stewardship.
在肺移植受者（LTRs）中，通过监测EBV病毒血症，并在达到特定病毒载量（VL）阈值时降低免疫抑制，是减轻从EBV病毒血症进展为移植后淋巴细胞增生性疾病（PTLD）的常见做法。EBV监测在成人EBV血清学阳性LTRs中的效用尚不清楚。
我们对2019年1月1日至2020年12月31日期间接受肺移植并接受全血（WB）EBV PCR监测的EBV血清学阳性成人LTRs进行了一项回顾性队列研究。我们比较了3组中的WB EBV VL峰值：1）在临床怀疑PTLD之前发生PTLD的无症状LTRs，2）在临床怀疑PTLD之后发生PTLD的LTRs，以及3）未发生PTLD的LTRs。我们计算了中度病毒血症（2840至11360 IU/mL）和高度病毒血症（≥11360 IU/mL）对识别活动性或未来PTLD的阳性预测值（PPV）。
229名LTRs中有6名（2.6%）发生了PTLD。在发生PTLD的LTRs中，怀疑PTLD后EBV VL峰值中位数显著高于PTLD临床症状出现之前（16004 IU/mL对≤568 IU/mL，p = 0.016）。后来发生PTLD的无症状LTRs与未发生PTLD的LTRs之间的EBV VL峰值中位数相似（EBV VL峰值中位数≤568 IU/mL对≤568 IU/mL，p = 0.62）。中度和高度病毒血症的PPV分别为14.7%和33.3%。
EBV监测不能准确识别有进展为PTLD风险的EBV血清学阳性LTRs。对无症状EBV血清学阳性移植受者进行EBV PCR检测可能是诊断管理的一个机会。
