Evaluation of Epstein-Barr virus (EBV) antibody screening of organ donors for allocation of organs to EBV serostatus matched recipients.

摘要

OBJECTIVE: Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication following organ transplantation. The greatest risk is seen in Epstein-Barr virus (EBV)-seronegative patients receiving allografts from EBV-seropositive donors. The severity and frequency of PTLD are particular concerns for pediatric patients, who frequently are EBV negative and hence more likely to be EBV infected from an EBV-positive organ donor. The aim of this study was to analyze the EBV serostatus of deceased organ donors and to assess the likelihood of recipient/donor matching for EBV serostatus. MATERIALS AND METHODS: Sera obtained from local deceased organ donors for the period 2004-2005 were retrospectively tested for EBV viral capsid antigen (VCA) IgG and IgM antibodies by an enzyme-linked immunosorbent assay (ELISA). The analysis included only data from those donors who were tested using a pretransfusion specimen (n = 459). The influence of various factors on the EBV serostatus of the donor was assessed, including age, gender, ethnicity, and cytomegalovirus (CMV) serostatus of the donor. RESULTS: Overall, only 27 (6%) of the 459 donors were EBV seronegative, with 94% being positive for IgG antibodies to EBV. A higher percentage of the EBV-seronegative donors were younger donors (age < or =35 years), compared with EBV-seropositive donors, 74% (n = 27) vs 31% (n = 432), P < .0001. A higher percentage (85%) of the younger (age < or =35 years) EBV-seronegative donors (n = 20) were also CMV seronegative. There was also a greater likelihood for the younger (age < or =35 years) CMV-seronegative donors to be EBV seronegative, compared with the older (age >35 years) CMV-seronegative donors, 20% (n = 83) vs 1% (n = 93), P < .0001. There was no influence of other factors examined on EBV serostatus. CONCLUSIONS: EBV-seronegative organ donors are infrequent and therefore provide only a limited supply of organs for patients in need of them. The higher frequency of EBV-seronegative donors being the younger donors will benefit the pediatric patients who have the greatest need for an EBV serostatus matched organ from a younger donor. Recent policy changes at the United Network for Organ Sharing (UNOS) giving priority to pediatric patients for kidneys from younger donors (age < or =35 years) and prospective EBV testing of donors will be helpful in the appropriate allocation of these organs.