Epstein-Barr viral infection in renal allograft recipients: a single center experience.

In this study we attempted to identify the factors involved in Epstein-Barr viral
(EBV) infection among renal allograft recipients. We studied 68 renal allograft recipients
hospitalized at the Imam Khomeini Medical Center from 2001 to 2004. Blood samples were
obtained from the patients before renal transplantation and repeated every 3 months during the first
year after transplantation. Enzyme linked immunosorbant assay (ELISA) tests were performed on
these samples to determine if antibodies to EBV antigens, such as viral capsid antigen(VCA)IgM,
VCAIgG or Epstein Barr neoantigen (EBNA)IgG, were present. The types of prescribed
immunosuppressive agents and the incidence of acute allograft rejection were closely observed to
define their association with EBV. EBV infection developed in 58 (85.3 %) patients and active
disease in 10 (14.7%). EBV was detected in 40 (58.8%) patients during the first year after
transplantation. There was EBNAIgG seropositivity in 65 (95.6%) patients before transplantation;
this number increased to 68 (100 %) after transplantation. In contrast, VCAIgG seropositivity
increased from 92.6% before transplantation to 96.9% after transplantation; whereas VCAIgM
seropositivity increased from 17.6% before transplantation to 58.8% after transplantation. There were
no statistically significant differences in the reactivation of EBV infection between the different
immunosuppressive regimens, between the groups of acute rejection and no acute rejection, or
between the groups that received and did not receive anti-lymphocyte globulin (ALG) We conclude
that most EBV activation after transplantation may represent a secondary form of a preexisting
infection and we could not find a clear association with a specific immunosuppressive regimen,
including the use of ALG. Further investigation is thus required to elucidate the factors involved in
the reactivation of the EBV infection in the transplant population.