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

San-Juan, R.; Manuel, O.; Hirsch, H.H.; Fernández-Ruiz, M.; López-Medrano, F.; Comoli, P.; Caillard, S.; Grossi, P.; Aguado, J.M.; Alamo-Martinez, J.M.; Anaya, F.; Anttila, V.-J.; Arnol, M.; Avolio, A.W.; Baccarani, U.; Castello, I.B.; Boletis, I.; Bonofiglio, R.; Bressollette, C.; Brockmann, J.; Caillard, S.; Pulido, J.C.; Catalan, P.; Christiansen, C.; Cofan, F.; Cordero, E.; Leiro, M.C.; Dantal, J.; D'armini, A.; Delgado, J.F.; Strologo, L.D.; Raimondo, F.D.; Dierickx, D.; Eis-Hübinger, A.; Kremer, S.F.; Faggian, G.; Farinas, M.C.; Folgueira, M.D.; Fontana, I.; Franco, A.; Furian, L.; Garzoni, C.; Ghirardo, G.; Ginevri, F.; Grinyo, J.; Gupte, G.; Hansson, L.; Helantera, I.; Herrero, J.I.; Hirsch, H.H.; Hobin, D.; Hoffmann, D.; Jan, L.; Jarque, I.; Jespersen, B.; Kaczmarek, I.; Kevin, P.; Koneth, I.; Kovac, D.; Lacaille, F.; Lautenschlager, I.; Len, O.; Llado, L.; Loy, M.; Manuel, O.; Marcos Maeso, M.A.; Marianne, L.V.; Marsh, J.; Meylan, P.; Minambres, E.; Montejo, M.; Mueller, N.; Munoz, P.; Nadalin, S.; Kamar, N.; Nicolas, B.; Olivier, D.; Palomo, J.; Pascual, M.; Peter, J.; Pierre, F.; Francisca Portero, M.; Provot, F.; Boluda, E.R.; Regalia, E.; Reina, G.; Reuter, S.; Ricart, J.; Garcia, M.R.; Rollag, H.; Russo, F.P.; Sabe, N.; Salcedo, M.; Santambrogio, L.; Seeman, T.; Serra, N.; Sgarabotto, D.; Simonek, J.; Thierry, Y.; Thomsen, M.K.; Tihic, N.; Torre-Cisneros, J.; Travi, G.; Tulissi, P.; Moal, V.; Veroux, M.; Santandreu, A.V.; Vizzini, G.; Zibar, L.; On behalf of the European Study Group of Infections in Compromised Hosts (ESGICH) from the European Society of Microbiology and Infectious Diseases (ESCMID); ESGICH PTLD Survey Study Group

doi:10.1016/j.cmi.2015.02.002

Article (Scientific journals)

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

San-Juan, R.; Manuel, O.; Hirsch, H.H. et al.

2015 • In Clinical Microbiology and Infection, 21 (6), p. 604.e1 - 604.e9

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https://hdl.handle.net/2268/305503

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10.1016/j.cmi.2015.02.002

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25686696

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Keywords :

Epstein-Barr virus; Europe; Post-transplant lymphoproliferative disease; Pre-emptive treatment; Survey; calcineurin inhibitor; fluorodeoxyglucose f 18; immunosuppressive agent; mammalian target of rapamycin inhibitor; rituximab; valganciclovir; virus DNA; target of rapamycin kinase; Article; assessment of humans; cross-sectional study; DNA determination; Epstein Barr virus; Epstein Barr virus infection; esgich questionnaire; graft recipient; health care access; health center; health program; health survey; high risk patient; human; immunosuppressive treatment; Internet; medical society; organ transplantation; positron emission tomography; posttransplant lymphoproliferative disease; priority journal; solid organ transplantation; virus load; whole body CT; antagonists and inhibitors; complication; Epstein-Barr Virus Infections; Lymphoproliferative Disorders; questionnaire; viremia; x-ray computed tomography; Human herpesvirus 4; Mammalia; Cross-Sectional Studies; Humans; Immunosuppressive Agents; Organ Transplantation; Positron-Emission Tomography; Rituximab; Surveys and Questionnaires; Tomography, X-Ray Computed; TOR Serine-Threonine Kinases; Transplant Recipients; Viral Load; Viremia

Abstract :

[en] 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. © 2015 European Society of Clinical Microbiology and Infectious Diseases.

Disciplines :

Surgery
Immunology & infectious disease

Author, co-author :

San-Juan, R.; Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain

Manuel, O.; Transplantation Centre and Service of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland

Hirsch, H.H.; Transplantation and Clinical Virology, Department Biomedicine, Infectious Diseases and oHospital Epidemiology, University of Basel, Basel, Switzerland

Fernández-Ruiz, M.; Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain

López-Medrano, F.; Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain

Comoli, P.; Pediatric Haematology-Oncology and Research Laboratories Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

Caillard, S.; Nephrology and Transplantation Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France, Strasbourg University Hospital, Strasbourg, France

Grossi, P.; National Centre for Transplantation, Infectious and Tropical Diseases Department, University of Insubria, Varese, Italy, Ospedale Di Circolo, Fondazione Macchi, Varese, Varese, Italy

Aguado, J.M.; Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain

Alamo-Martinez, J.M.; Virgen Del Rocio Hospital Infantil, Sevilla, Spain

More authors (101 more)

Other collaborator :

Detry, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation

Language :

English

Title :

Publication date :

2015

Journal title :

Clinical Microbiology and Infection

ISSN :

1198-743X

eISSN :

1469-0691

Publisher :

Elsevier

Volume :

Issue :

Pages :

604.e1 - 604.e9

Peer reviewed :

Peer Reviewed verified by ORBi

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