Association between Epstein-Barr virus infection and late acute transplantrejection in long-term transplant patients

Recently we reported about a possible involvement of extrarenal systemic cy tomegalovirus (CMV) infection in graft deteriorating immune processes. We n ow examined whether Epstein-Barr virus (EBV) may also be associated with la te renal graft injury. We analyzed the expression of early antigen., viral capsid antigen-, and a latency-associated EBV-RNA-transcript, which is not translated into protein in peripheral blood mononuclear cells of kidney tra nsplant patients with histologically proven late acute rejection and no sig ns of CMV or any other infection (A), patients with stable graft function ( B), and healthy probands (C). A total of 40% in group A vs. 5 and 0% in gro ups B and C, respectively, expressed early antigen-mRNA (P <0.05) suggestin g an activation of lytic EBV infection. Response to steroid bolus therapy i n group A was comparably poor with that observed in CMV-related graft injur y. Our data suggest that extrarenal lytic EBV infection may also be involve d in the pathogenesis of late graft injury. A controlled ganciclovir trial may prove the significance of our observation.