EPSTEIN-BARR-VIRUS TRANSMISSION FROM A BLOOD-DONOR TO AN ORGAN TRANSPLANT RECIPIENT WITH RECOVERY OF THE SAME VIRUS-STRAIN FROM THE RECIPIENTS BLOOD AND OROPHARYNX

A previous study (Savoie et al, Blood 83:2715, 1994) identified eight transplant patients who acquired Epstein-Barr virus (EBV) infection du ring the peritransplant period. Three of these patients subsequently d eveloped B-cell lymphoproliferative disease within 4 months of transpl antation. Among these, there was a 16-year-old liver transplant patien t who was negative for EBV at the time of transplant and who received an EBV-negative organ. After transplant, this patient was transfused w ith 9 U of packed red blood cells. Eight of the donors were EBV-positi ve and one was EBV-negative. We succeeded in obtaining spontaneous lym phoblastoid cell lines (LCLs) from the blood of three of these donors, one of whom also yielded a cord-blood line established with his throa t-wash EBV. Blood from a fourth donor did not yield an LCL, but his th roat washing did have transforming activity when inoculated onto cord- blood leukocytes. We initially could establish spontaneous LCLs only f rom the recipient's blood. However, a throat-wash sample taken 11 week s later did show transforming activity. The recipient was shown to hav e acquired the EBV infection from one of eight EBV-seropositive blood donors. Analysis of fragment length polymorphisms after polymerase cha in reaction amplification of the EBV BamHI-K fragment was used to esta blish strain identity. Western blot analysis for existence of size pol ymorphisms in three classes of Epstein-Barr nuclear antigens (EBNA-1, EBNA-2, and EBNA-3) confirmed the DNA results. It is noteworthy that t he blood donor responsible for transmitting his EBV strain to the reci pient had experienced clinical infectious mononucleosis 15 months befo re donating blood. Our results may, thus, indicate a requirement for l eukodepletion of blood destined for immunosuppressed EBV-negative pati ents. Finally, blood donors with a recent history of infectious mononu cleosis should probably be identified so that their blood is not given to EBV-negative transplant patients. (C) 1996 by The American Society of Hematology.