Prevention of Epstein-Barr Virus Associated Post-Transplant Lymphoproliferative Disorder

Faculty

Needs Statement

Post-transplant lymphoproliferative disorders (PTLD) encompass a wide spectrum of mainly B-cell lymphoproliferative disorders with severity ranging from benign polyclonal syndromes to malignant monoclonal lymphoproliferative malignant diseases.  At clinical presentation, PTLD may be localized or widely disseminated, and may commonly involve the transplanted allograft.

Epstein-Barr virus (EBV) is the causative agent of the vast majority of PTLD.  Patients who are EBV seronegative at the time of transplantation are at highest risk for uncontrolled primary EBV infection and EBV-related PTLD, following transplantation of an organ from an EBV-seropositive donor (EBV D+/R- mismatch status).  In addition, CMV disease, CMV mismatch, Caucasian race, and male gender have been identified as other potential risk factors. The risk of PTLD also varies among the transplanted organ. Kidney, liver, heart, pancreas, lung, heart-lung, intestinal, and multivisceral organ transplant recipients are at increasing risk, respectively, of developing PTLD.  Post-transplant over-immunosuppression has also been implicated as a factor influencing the occurrence of EBV infection and PTLD. It is likely that the overall dose and duration of pharmacologic immunosuppression have a direct effect on the development of PTLD.

Multiple clinical studies have suggested that antiviral prophylactic or preemptive treatment for CMV reduces not only CMV disease itself, but also the risk for EBV associated disease following transplantation.  Passive transfer of anti-EBV immunoglobulins has also been used to prevent EBV disease after transplantation. CMV hyperimmune globulin (CMV-IVIg; CytoGam®, CSL Behring, King of Prussia, PA), which contains anti-EBV antibody titers of up to 100-fold greater than those found in conventional IVIg, has been used most commonly.

The present activity will review the incidence, risk factors, and outcomes of EBV infection and PTLD in solid organ transplant recipients.  The potential role of antiviral medications and anti-EBV antibodies in controlling infection and its progression to clinical disease will be described.  Finally, studies of the use of antiviral agents and CMV-IVIg to prevent EBV infection and disease will be discussed.

 

Target Audience

This educational activity is intended for medical professionals involved in the management of transplant patients including: transplant physicians, surgeons, nurses and pharmacists.

Objectives

1. Discuss the epidemiology of PTLD after solid organ transplantation;
2. Assess the risk factors, clinical features, and outcomes of PTLD after solid organ transplantation;
3. Discuss multiple strategies for the prevention of PTLD after solid organ transplantation.

Accreditation

Medicine
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Kentucky College of Medicine and CTI Clinical Trial & Consulting Services. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this educational activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Each physician should claim only those hours of credit actually spent in the educational activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

Pharmacy
The University of Kentucky College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

This activity has been assigned ACPE # 022-999-08-105-H04-P and will award up to 1.00 contact hours (0.1 CEUs) of continuing pharmacy education credit in states that recognize ACPE providers.

Statements of credit will indicate hours and CEUs based on participation and will be issued online at the conclusion of the activity. Successful completion includes completing the activity, its accompanying evaluation and/or posttest and requesting credit online at conclusion of the activity. The College complies with the Accreditation Standards for Continuing Pharmacy Education.

Nursing
AdvancMed, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

AdvancMed is a provider approved by the California Board of Registered Nursing, Provider #13429. AdvancMed provides this activity for 1.00 nursing contact hour(s).

Faculty Disclosure

Dr. Razonable is a site principal investigator for a clinical trial sponsored by ViroPharma, Inc, and is a recipient of a research grant from Roche Pharmaceuticals.

Activity Sponsorship

This activity is jointly sponsored by the University of Kentucky and CTI Clinical Trial & Consulting Services. Supported by an unrestricted educational grant from CSL Behring.