The Impact of Epstein-Barr Virus Serostatus Mismatch in Adult Kidney Transplant Recipients: An Analysis of the 2012-2022 OPTN Database.

BACKGROUND AND AIMS: One strategy to minimize the risk of posttransplant lymphoproliferative disorder (PTLD) is to avoid an Epstein-Barr Virus (EBV) mismatch through kidney paired donation. We aimed to estimate the incidence of PTLD in EBV-negative kidney transplant recipients with EBV-positive donors (D+/R-) and evaluate the excess risk of death following the occurrence of PTLD.

METHODS

We included adult patients in OPTN database who underwent kidney transplants between 2012 and 2022. Cox regression analysis was employed to evaluate the impact of EBV serostatus on the development of PTLD, and to assess mortality following PTLD diagnosis in D+/R- individuals.

RESULTS

A total of 179 068 patients were included, with 92.8% in the R+, 6.4% in the D+/R-, and 0.8% in the D-/R- group. D+/R- exhibited a significantly higher risk of PTLD compared to R+ and D-/R- groups. D+/R- had a greater risk of PTLD when compared to D-/R- recipients (aHR: 3.82; p < 0.001). Among D+/R- recipients, those who developed PTLD had a significantly higher risk of mortality (aHR: 2.28; p < 0.001 in deceased donor kidney transplant [DDKT] and aHR: 5.22; p < 0.001 in living donor kidney transplant [LDKT]).

CONCLUSIONS

D+/R- recipients have nearly a fourfold higher risk of PTLD compared to D-/R- recipients, suggesting that choosing an EBV D-/R- transplant could reduce the PTLD risk by about 73%. This data is crucial for counseling EBV-negative patients considering kidney paired donation to avoid an EBV serostatus mismatch.