RAPID OCCURRENCE OF LYMPHOPROLIFERATIVE DISEASE AFTER PANCREAS-KIDNEYTRANSPLANTATION PERFORMED DURING ACUTE PRIMARY EPSTEIN-BARR-VIRUS INFECTION

Generalized lymphoproliferative disease occurred in a 30-year-old woma n 15 days after she underwent simultaneous pancreas-kidney transplanta tion Because of the rapid progression of this disorder, it was necessa ry to remove the grafts and discontinue immunosuppression 19 days afte r transplantation. Serological analysis demonstrated that the patient, who was Epstein-Barr virus (EBV)-seronegative 3 months before, was se roconverting at the time of the transplantation EBV therefore was acqu ired just before the transplantation, either by a blood transfusion 4 months earlier or from the patient's EBV-positive boyfriend. The latte r source appeared most likely, as concluded from the investigation of the EBV strains from the patient's boyfriend and from the blood and or gan donors. Donor origin of lymphoblastoid cells was excluded by sex c hromosomal analysis. Initiation of immunosuppression during a primary EBV infection carries the risk of very rapid development of B-celr lym phoproliferative disease. This emphasizes the need for active monitori ng of EBV infections in transplant recipients and for the development of preventive strategies.