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Title Epstein-Barr Virus Infection in Adult Renal Transplant Recipients
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Publication Date
Degree Level doctoral
University/Publisher University of Manchester
Abstract Aims: To explore the clinical significance of EBV infection in adult renal transplant recipients when detected in the late post-transplant period.Methods: (1) A prospective observational study recruiting 499 stable adult kidney transplant recipients with serial blood sampling for EBV DNAemia and assessment of clinical outcomes and associated factors. (2) A retrospective analysis of PTLD incidence, timing and outcomes in relation to EBV infection. Results: EBV DNAemia in stable kidney transplant recipients is common, found in 46% of recruited individuals screened over 1 year, with persistent DNAemia seen in 10%. DNAemia prevalence increased significantly with time from transplant (p<0.0001) from 16% within 1 year of transplant to 66% in those transplanted for 20-24 years. High baseline DNA levels predicted persistence of DNAemia. Time adjusted analyses showed significant association of DNAemia with EBV seronegative status and previous PTLD and low DNAemia rates with Mycophenolate Mofetil (MMF) use and lymphopenia. The mechanism did not appear to be directly linked to MMF induced B cell depletion. Chronic high viral load detection was significantly associated with time from transplant, EBV seronegative status at transplant, ciclosporin use and plasma detection of DNA. No significant differences in overall patient survival at 3 years, clinical symptoms or clinical findings such as anaemia, thrombocytopenia or rate of decline in renal function were seen between stable transplant recipients with and without EBV DNAemia. PTLD incidence also increases with time from transplant and was greatest during the 10th-14th post-transplant years. Disease was EBV positive in 68% cases. No statistically significant differences in overall patient survival, or overall disease complete response rates were seen in relation to recipient EBV serostatus or EBV status of PTLD histology. Conclusions: EBV DNAemia prevalence increases with time from transplant but was not associated with worse patient or graft survival or specific symptoms. PTLD incidence including EBV negative disease also increases with time from transplant but response rates and survival were not influenced by EBV serostatus or histological status.
Subjects/Keywords Epstein-Barr virus; Transplant; Immunosuppression; Post-transplant lymphoproliferative disorder; Kidney
Contributors KLAPPER, PAUL P; Vallely, Pamela; Klapper, Paul
Language en
Country of Publication uk
Format 277 page(s)
Record ID oai:escholar.manchester.ac.uk:uk-ac-man-scw-210214
Repository manchester
Date Retrieved
Date Indexed 2020-09-08

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…187 8 The University of Manchester David Muir Morton A Thesis submitted to the University of Manchester for the degree of Doctor of Philosophy in the Faculty of Medical and Human Sciences Epstein-Barr Virus Infection in Adult Renal Transplant…

…rights in it (the “Copyright”) and he has given The University of Manchester certain rights to use such Copyright, including for administrative purposes. ii. Copies of this thesis, either in full or in extracts and whether in hard or electronic…

Manchester undertaken September 2009- 12 September 2012. The author graduated from the University of Manchester with an MBBS in 2002 having achieved an MA (Hons) in History at the University of Edinburgh 1996. After obtaining the MRCP (UK…

…support was 13 provided by Steve Roberts (University of Manchester) and supervision, review of experiments and paper review by Pamela Vallely, Mike Picton, Beatrice Coupes, Paul Klapper, Kate Ryan, Julie Adams, John Burthem, Richard Byers and…

…with my hours in the office and lack of play. The Author The author of this work is currently a Locum Consultant Nephrologist at Manchester Royal Infirmary. The research presented in this thesis was performed as part of a PhD at the University of

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