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633) A kidney transplant patient receiving chronic immunosuppressive medication presents with lymphadenopathy. He was Epstein-Barr virus (EBV) negative before transplantation and received an allograft from an EBV-positive donor. Flow cytometry (FC) of a biopsy shows both Ig κ and λ staining of the B-cell gate. Which one of the following is true?

The patient is not at risk for EBV lymphoma. EBV reactivation in immunocompromised patients is due to humoral insufficiency and can be overcome with intravenous immunoglobulin (IVIg) treatment. B-cell proliferation in EBV lymphoproliferative disorders is due to B-cell receptor-mediated B-cell recognition of EBV antigens. The receptor for EBV viral entry on B cell is the complement receptor CD21. EBV lymphoma is less commonly seen in pediatric transplants since posttransplant lymphoproliferative disorder is due to EBV reactivation from prior infection.

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• Donor/recipient viral serology matching plays in important role in transplantation, having a major impact on mortality and morbidity.

• Allografts can transfer infection to a previously unexposed individual.

• In the United States, over 90% of the adult population is Epstein-Barr virus (EBV) seropositive and 50% to 80% is cytomegalovirus (CMV) positive. Seroprevalence is age dependent.

• Upon chronic immunosuppression, viral infections, which are kept under immunologic control in healthy individuals, can reactivate and become life threatening.

• Posttransplant lymphoproliferative diseases (PTLDs) are dependent on the transplanted organ and level of immunosuppression. The highest incidence of PTLDs is observed in small bowel and multiple organ transplants (5% to 20%), followed by thoracic allografts (2% to 10%), and then by renal and liver transplants (1% to 5%).

Nourse JP, Jones K, Gandhi MK: Epstein-Barr virus-related post-transplant lymphoproliferative disorders: pathogenetic insights for targeted therapy. Am J Transplant 2011;11:888-895.

Dharnidharka VR, Tejani AH, Ho PL, et al: Post-transplant lymphoproliferative disorder in the United States: young Caucasian males are at highest risk. Am J Transplant 2002;2:993-998.

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Clinical Pathology: General Principles, Immunology & Histocompatibility

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