PRETRANSPLANTATION SERONEGATIVE EPSTEIN-BARR-VIRUS STATUS IS THE PRIMARY RISK FACTOR FOR POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER IN ADULT HEART, LUNG, AND OTHER SOLID-ORGAN TRANSPLANTATIONS

Background: The relative importance and interrelationship of risk fact ors for posttransplantation lymphoproliferative disorder are poorly un derstood. Methods: The prospective pretransplantation serologic testin g for Epstein-Barr virus of all nonrenal solid organ transplant recipi ents at our institution made it possible to assess the relative risk f or posttransplantation lymphoproliferative disorder in seropositive an d seronegative recipients. Results: Fourteen cases of lymphoproliferat ive disorder were identified in the first 389 consecutive transplant r ecipients (288 liver, 44 heart, 20 lung, 37 kidney-pancreas) undergoin g transplantation from 1985 to 1992 (mean follow-up 33 months). The in cidence rates of lymphoproliferative disorder (per 100 person-years) d uring the first 2 years after transplantation (a period in which all c ases occurred) were 1.4 for liver, 2.0 for heart, 6.2 for lung, and 5. 2 for kidney-pancreas transplant recipients and were significantly dif ferent between liver and lung (p = 0.005) and liver and kidney-pancrea s (p = 0.002) groups. Of 367 seropositive patients, lymphoproliferativ e disorder developed in only three. The incidence rate ratios between seronegative and seropositive recipients were as follows: 76 ([95% con fidence interval; 46, 144], p = 0.0000) for any form of lymphoprolifer ative disorder and 145 ([60, 347], p = 0.0000) for fatal or brain form s. The incidence rate of lymphoproliferative disorder was significantl y higher for seronegative recipients who required antilymphocyte antib ody therapy for rejection than for those who received none. Conclusion s: The high intrinsic risk for lymphoproliferative disorder in the Eps tein-Barr virus seronegative patient, which is amplified by higher lev els of immunosuppression, may, in some instances, preclude transplanta tion.