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, ESGICH PTLD Survey Study Group,, European Study Group of Infections in Compromised Hosts (ESGICH) from the European Society of Microbiology and Infectious Diseases (ESCMID), José María Álamo-Martínez, Fernando Anaya, Veli-Jukka Anttila, Miha Arnol, Alfonso W Avolio, Umberto Baccarani, Isabel Beneyto Castello, Ioannis Boletis, Renzo Bonofiglio, Annunziata Viamigliori, Celine Bressollette, Jens Brockmann, Sophie Caillard, Jorge Calvo Pulido, Pilar Catalán, Claus Christiansen, Frederic Cofan, Elisa Cordero, Marisa Crespo Leiro, Jacques Dantal, Andrea D'armini, Andrea D'armini, Juan F Delgado, Luca Dello Strologo, Bambino Gesu, Francesco Di Raimondo, Daan Dierickx, Anna Eis- Hübinger, Samira Faf Kremer, Giuseppe Faggian, María Carmen Fariñas, Maria Dolores Folgueira, Iris Fontana, Antonio Franco, Lucrezia Furian, Christian Garzoni, Giulia Ghirardo, Fabrizio Ginevri, Josep Grinyó, Paolo Antonio Grossi, Girish Gupte, Lennart Hansson, Ilkka Helanterä, Jose Ignacio Herrero, Hans H Hirsch, David Hobin, Dieter Hoffmann, Lerut Jan, Isidro Jarque, Bente Jespersen, Ingo Kaczmarek, Grosshadern Klin, Pilarczyk Kevin, Irene Koneth, Damjan Kovac, Florence Lacaille, Irmeli Lautenschlager, Oscar Len, Laura Lladó, Monica Loy, Oriol Manuel, Maria Angeles Marcos Maeso, Leruez-Ville Marianne, James Marsh, Pascal Meylan, Eduardo Miñambres, Miguel Montejo, Nicolas Mueller, Patricia Muñoz, 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, M José Ricart, Minerva Rodríguez García, Halvor Rollag, Francesco Paolo Russo, Núria Sabé, 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, Valérie Moal, Massimiliano Veroux, Ana Vila Santandreu, Giovanni Vizzini, Lada Zibar, R San-Juan, O Manuel, H H Hirsch, M Fernández-Ruiz, F López-Medrano, P Comoli, S Caillard, P Grossi, J M Aguado, ESGICH PTLD Survey Study Group,, European Study Group of Infections in Compromised Hosts (ESGICH) from the European Society of Microbiology and Infectious Diseases (ESCMID), José María Álamo-Martínez, Fernando Anaya, Veli-Jukka Anttila, Miha Arnol, Alfonso W Avolio, Umberto Baccarani, Isabel Beneyto Castello, Ioannis Boletis, Renzo Bonofiglio, Annunziata Viamigliori, Celine Bressollette, Jens Brockmann, Sophie Caillard, Jorge Calvo Pulido, Pilar Catalán, Claus Christiansen, Frederic Cofan, Elisa Cordero, Marisa Crespo Leiro, Jacques Dantal, Andrea D'armini, Andrea D'armini, Juan F Delgado, Luca Dello Strologo, Bambino Gesu, Francesco Di Raimondo, Daan Dierickx, Anna Eis- Hübinger, Samira Faf Kremer, Giuseppe Faggian, María Carmen Fariñas, Maria Dolores Folgueira, Iris Fontana, Antonio Franco, Lucrezia Furian, Christian Garzoni, Giulia Ghirardo, Fabrizio Ginevri, Josep Grinyó, Paolo Antonio Grossi, Girish Gupte, Lennart Hansson, Ilkka Helanterä, Jose Ignacio Herrero, Hans H Hirsch, David Hobin, Dieter Hoffmann, Lerut Jan, Isidro Jarque, Bente Jespersen, Ingo Kaczmarek, Grosshadern Klin, Pilarczyk Kevin, Irene Koneth, Damjan Kovac, Florence Lacaille, Irmeli Lautenschlager, Oscar Len, Laura Lladó, Monica Loy, Oriol Manuel, Maria Angeles Marcos Maeso, Leruez-Ville Marianne, James Marsh, Pascal Meylan, Eduardo Miñambres, Miguel Montejo, Nicolas Mueller, Patricia Muñoz, 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, M José Ricart, Minerva Rodríguez García, Halvor Rollag, Francesco Paolo Russo, Núria Sabé, 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, Valérie Moal, Massimiliano Veroux, Ana Vila Santandreu, Giovanni Vizzini, Lada Zibar
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.
Keywords: Epstein–Barr virus; Europe; post-transplant lymphoproliferative disease; pre-emptive treatment; survey.
Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Source: PubMed