Frequent monitoring of Epstein-Barr virus DNA load in unfractionated wholeblood is essential for early detection of posttransplant lymphoproliferative disease in high-risk patients

Posttransplant lymphoproliferative disease (PTLD) is a frequent and severe Epstein-Barr virus (EBV)-associated complication in transplantation recipie nts that is caused by iatrogenic suppression of T-cell function, The diagno stic value of weekly EBV DNA load monitoring was investigated in prospectiv ely collected unfractionated whole blood and serum samples of lung transpla ntation (LTx) recipients with and without PTLD, In PTLD patients, 78% of te sted whole blood samples were above the cut-off value of quantitative compe titive polymerase chain reaction (Q-PCR) (greater than 2000 EBV DNA copies per mt blood), with the majority of patients having high viral loads before and at PTLD diagnosis. Especially in a primary EBV-infected patient and in patients with conversion of immunosuppressive treatment, rapid increases i n peripheral blood EBV DNA load diagnosed and predicted PTLD, In non-PTLD t ransplantation recipients, only 3.4% of the whole blood samples was above t he cutoff value (P < .0001) despite heavy immune suppression and cytomegalo virus (CMV)-related disease, These findings illustrate the clinical importa nce of frequent EBV DNA load monitoring in LTx recipients. The increased EB V DNA loads in PTLD patients were restricted to the cellular blood compartm ent, as parallel serum samples were all below cut-off value, which indicate s absence of lytic viral replication, EBV+ cells in PTLD patients have a ve ry short doubling time, which can be as low as 56 hours, thereby creating t he need for high screening frequency in high-risk patients. Furthermore, it is shown that EBV and CMV can reactivate independently in LTx recipients a nd that EBV DNA load monitoring may be useful in discriminating PTLD from r ejection. (Blood, 2001;97:1165-1171) (C) 2001 by The American Society of He matology.