Prospective monitoring of Epstein-Barr virus DNA in adult renal transplant recipients during the early posttransplant period: role of mycophenolate mofetil

Background. Epstein-Barr virus (EBV) is associated with posttransplant lymphoproliferative disease. We monitored the incidence of EBV viraemia in adult renal transplant recipients and investigated the association with clinical parameters. Methods. Whole blood from 115 renal transplant patients was tested regularly by quantitative polymerase chain reaction (PCR) assay for EBV DNA during the first 90 days posttransplantation. Results. Sixty four of 115 (56%) patients had detectable EBV DNA in blood (>100 copies/mL) on at least one occasion. The median time to first DNA detection was 15 days post-transplant and median viral load was 598 copies/mL (range 119–53,649 copies/mL). Multivariate Cox-regression analyses showed that patients receiving mycophenolate mofetil (MMF) on the day of transplant had a significantly lower risk of EBV viraemia compared to those who received no MMF (Hazard ratio=0.518, 95% CI 0.307–0.875, p=0.014). Conclusions. EBV viraemia is common during the early posttransplant period in adult renal transplant recipients. Our results suggest a role of MMF in preventing EBV viraemia, however further work is required to identify the mechanism(s) involved.