Monitoring Epstein–Barr viral load may reduce PTLD incidence after liver transplant

Epstein‒Barr virus (EBV) viral load (VL) monitoring can help lower the incidence of post-transplant lymphoproliferative disease (PTLD) following liver transplant in adults, suggests a study.

This cohort study at two university medical centres in the Netherlands included adult recipients of first liver transplant in Leiden between September 2003 and January 2017 with an EBV VL monitoring strategy (monitoring group), recipients of first liver transplant in Rotterdam between January 2003 and January 2017 without such a strategy (contemporary control group), and those who had transplants in Leiden between September 1992 and September 2003 or Rotterdam between 1986 and January 2003 (historical control groups).

The research team assessed the impact of EBV VL monitoring on PTLD incidence. They also conducted inverse probability of treatment weighting to achieve balance among the groups for relevant patient characteristics.

Differences within hospital in cumulative incidences—expressed as the number of events per 1,000 patients measured at 5-, 10-, and 15-year follow-up—exhibited fewer events in the contemporary versus the historical era in both centres. Such difference was much larger in the monitoring centre, while the 95 percent confidence interval included the null value for point estimates.

As a limitation, “[r]etrospective, low statistical power, and incompletely balanced groups, and non-EBV PTLD cannot be prevented,” according to the researchers, adding that larger studies are warranted.

“Primary infection with or reactivation of EBV can occur after liver transplant and can lead to PTLD,” they noted.