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Diagnosis, prevention, and management of Epstein-Barr virus-associated posttransplant lymphoproliferative disorders in organ transplant recipients

Purpose of reviewEpstein-Barr virus-driven posttransplant lymphoproliferative disorders remain a significant complication of solid organ transplantation. Routine monitoring of Epstein-Barr virus loads for detection and prevention of posttransplant lymphoproliferative disorders is now well accepted, whereas the range of therapies for the treatment of posttransplant lymphoproliferative disorders continues to grow. This article reviews recent progress in both areas, which have advanced the science and clinical management of Epstein-Barr virus-related posttransplant lymphoproliferative disorders. Recent findingsRecent studies continue to refine the understanding of Epstein-Barr virus loads and other markers to improve the specificity of posttransplant lymphoproliferative disorder prediction. Epstein-Barr virus-specific T-cell reactivity correlates with susceptibility to Epstein-Barr virus-driven posttransplant lymphoproliferative disorders in a complementary manner with viral loads, and may improve diagnostic accuracy. Other work examining reactivity to specific viral gene products and Epstein-Barr virus polymorphisms may aid in this determination. Advances in therapy of posttransplant lymphoproliferative disorders include the primary use of the anti-CD20 monoclonal antibody rituximab combined with antivirals and decreased immunosuppression, whereas preliminary data on the use of autologous or allogeneic Epstein-Barr virus-specific cytotoxic T lymphocytes suggest that they may have significant role in treatment. Improved chemotherapy regimens have also shown increased efficacy in the treatment of high-grade posttransplant lymphoproliferative disorder, which resembles B-cell lymphomas. SummaryAdvances in posttransplant lymphoproliferative disorders diagnosis and therapy have improved outcomes for solid organ transplant patients. Many of the new therapies, including cytotoxic T lymphocytes and rituximab, deserve larger, controlled trials to evaluate their effectiveness. Improvements in understanding of viral load and an increasing number of secondary markers should allow better prediction of who is at risk of progressing to posttransplant lymphoproliferative disorders and which patients would benefit from preventive algorithms.