Mono-oligoclonal immunoglobulin abnormalities in diabetic patients after kidney transplantation: influence of simultaneous pancreas graft

Associations of serum EBV DNA and gammopathy with post-transplant lymphoproliferative disease

BACKGROUND

Post-transplant lymphoproliferative disease (PTLD) is a life-threatening complication of immunosuppression following transplantation. Epstein-Barr virus (EBV) and gammopathy in serum are associated with PTLD, but these two parameters have not been evaluated in parallel for their association with PTLD.

METHODS

We evaluated the incidence of EBV load positivity, gammopathy, and protein expression in sera from all PTLD patients diagnosed at our hospital during the past seven yr. Results were compared with those of a control group including matched transplanted patients who did not develop PTLD.

RESULTS

Seven of 10 PTLD patients presented EBV(+) PTLD, for which five patients had detectable serum EBV DNA levels compared with none of 38 controls (RR between two groups =121, p < 0.0001). Five out of 10 patients had gammopathy at PTLD diagnosis compared with 5/38 controls (RR between two groups = 6.6, p = 0.022). Additionally, protein serum analysis by high-resolution two-dimensional gel electrophoresis and image examination failed to evidence specific abnormality in patients with PTLD compared with controls.

CONCLUSIONS

Our results confirm an association between EBV in sera and gammopathy with PTLD, and highlight the high specificity of the former analysis. Whether a combination of both analyses will improve the clinical detection of PTLD remains to be evaluated in a larger prospective cohort study.

Sustained remission of an extensive monoclonal, Epstein-Barr virus-associated diffuse large B cell lymphoma in a kidney-pancreas transplant recipient

BACKGROUND

Epstein-Barr virus associated posttransplant high-grade large cell lymphoma (EBV-PTL) is thought to be incurable solely by cessation of immunosuppression. We report a case of EBV-PTL resolving rapidly after alleviation of immunosuppression. A strong cytotoxic memory T cell (CTL) reaction against two individual recipient EBV strains appears to be involved.

METHODS

EBV strain identification in donor lymphocytes, tumor cells of EBV-PTL, and circulating lymphocytes of recipient was performed by latent membrane protein 1 fingerprinting.

RESULTS

Stage IIIB EBV-PTL of recipient type was cured through strong autologous CTL reaction consecutive to alleviation of immunosuppression. Latent membrane protein 1 fingerprinting identified three different EBV strains; namely in lymphoma and peripheral lymphocytes of donor and recipient.

CONCLUSION

In the setting of solid organ transplantation, rigorous reduction of immunosuppression may lead to cure of high grade EBV-PTL, if the recipient delivers a strong host CTL reaction against the epitopes of EBV latency gene products. Infection with two individual EBV strains earlier in life may increase the number of specific CTL clones and increase the memory capacity.