EBV-Associated PTLD: Improving Understanding and Outcomes

Post-transplant lymphoproliferative disease (PTLD) is a significant complication of organ transplantation. PTLD is typically related to Epstein-Barr virus (EBV) infection. Immunosuppression after transplant increases the risk of viral infections and malignancy, including EBV-associated PTLD, which can lead to morbidity and mortality.

Our division has been working through our hospital’s Transplant Center to improve monitoring for EBV infection after solid organ transplant in an effort to learn more about its association with PTLD. Through the Transplant Center, we have an ongoing quality improvement project that includes representatives from kidney, heart, lung, and liver transplant, infectious diseases, and oncology to standardize the screening for EBV after transplant, identify the highest risk patients, and discuss the management of patients with concern for PTLD.

The effort has identified that children without prior exposure to EBV are at highest risk of PTLD if they develop persistent EBV after transplant. We are currently learning about the best approaches to lower immunosuppression and improve referrals to oncology for proper imaging and management. Expanding on these clinical and quality improvement efforts, researchers in our division are collaborating with infectious diseases, oncology, and laboratory medicine to improve the diagnostic tests and treatment options available for these patients.