Post-Transplant Lymphoproliferative Disorder (PTLD); A Descriptive Cross Sectional Study Describing the Presence of Associated Factors for PTLD in a Cohort of First Year Post Renal Transplant Patients in Sri-Lanka

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Abstract

Introduction

PTLD has a prevalence of 1-3% among renal transplant recipients and a mortality rate of 40% within first post-transplant year.It is mostly due to active EBV infection during post-transplant period.Many guidelines recommend pre-transplant EBV serology guided post-transplant monitoring of high-risk renal transplant recipients {donor positive (D+)/ recipient negative(R-)} to initiate early pre-emptive therapy to control/prevent disease.Sri-Lanka, being a developing country is yet to implement this due to limited resources, although chronic kidney disease burden is high and many transplants are performed annually.Pre/post-transplant EBV infection nor PTLD among renal transplant recipients has never being studied so far.The current study aims to evaluate presence of some selected PTLD associated factors, presence of active EBV infection within the first post-transplant year and the practice of pre-transplant EBV serology testing in a cohort of renal transplant recipients.

Materials and Methods

A descriptive cross sectional study was conducted using 118 adult first-year post-renal transplant patients visiting two main transplant centers in Sri-Lanka over four months. Associated factors observed were, recipient EBV sero-negativity at transplantation, age of recipient(>60years), use of immunosuppressive drugs implicated for PTLD, HLA-B locus mismatch and presence of high-risk HLA types in recipient.Active EBV infection evaluated by testing plasma of recruits for EBV DNA using a commercially validated quantitative real-time PCR kit.Data on associated factors collected using clinical records.Informed written consent taken and ethical approval obtained from all relevant authorities.

Results

Mean age was 44.97(SD12.48) years,54.3% were > 6 months post-transplant,90.8% received live related kidney.Pre-transplant EBV serology available in 37/118 recipients, donor serology in 27/118 recipients -13 IgG,12 IgM and 2 had both IgM and IgG results.Sero-compatibility details available in only 15/118 with 46.6% being EBV sero-negative(20% were D+/R-).Only 11.86% were >60 years.All recruits were on Tacrolimus, none had received ATG nor other high-risk immunosuppressive drugs.79.01% had at least one HLA-B locus mismatch and high-risk recipient HLA types were present. All samples were negative for EBV DNA despite ensuring maximum viral DNA recovery.

Conclusion

Many recruits were EBV sero-negative at transplantation and all recruits had at least one associated factor observed in the study. Pre-transplant screening for EBV infection was poor with incorrect antibody selection in donor.None had active EBV infection at the time of testing;use of single sample per patient, few recruits in early transplant period and short study period may have affected EBV DNA detection rate.Findings emphasize the need for implementing routine pre-transplant EBV serology guided post-transplant monitoring for active EBV infection to improve the quality of care following transplantation.

Conclusion

Medical Research Institute, Colombo, Sri Lanka.

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