Could Epstein-Barr Virus Be The Silent Trigger For Cancer After Kidney Transplant?

Kidney transplants can be life-saving, but new research suggests that some recipients may face a higher risk of developing a rare and aggressive cancer known as post-transplant lymphoproliferative disorder (PTLD). This condition is linked to the Epstein-Barr virus (EBV), which is known for causing mononucleosis but is also associated with several types of cancer.

A recent study published in the Annals of Internal Medicine analyzed data from two large US transplant centres and found that kidney transplant patients who had never been exposed to EBV were at significant risk if they received an organ from a donor who had previously carried the virus.

The Link Between EBV and PTLDMore than 90 per cent of adults in the US have had an EBV infection at some point in their lives. However, when a kidney transplant patient who has never been exposed to the virus receives an organ from an EBV-positive donor, their immune system may struggle to fight the virus. This increases their risk of developing PTLD.

The study found that 22 per cent of these high-risk kidney transplant recipients developed PTLD within three years of transplantation. Nearly one-third of those who developed PTLD died from it during the study period.

Why Kidney Transplant Patients Are at RiskKidney transplant patients must take immunosuppressive medications to prevent their body from rejecting the new organ. While these drugs are essential for a successful transplant, they also weaken the immune system, making patients more vulnerable to infections like EBV and increasing the risk of developing PTLD.

The study reveals that up to 5 per cent of adult kidney transplant patients, around 1,200 people per year—may be at risk for PTLD. This number is five to ten times higher than previous estimates based on national registry data.

Dr Vishnu Potluri, one of the study authors, explained that current national registry data may not reveal the accurate number of PTLD cases due to incomplete reporting. Until now, PTLD research has mostly focused on children, who are less likely to have been exposed to EBV.

Dr Chethan Puttarajappa, another study author, explains the urgency of these findings. “Given the significant threat to survival posed by PTLD, we need further research to improve the safety of kidney transplant recipients,” he said. Experts now suggest that monitoring for EBV should become a routine part of post-transplant care.

What Can Be Done?

Dr Emily Blumberg, director of Transplant Infectious Diseases at Penn Medicine, says that early and regular screening for EBV is important. Doctors should consider adjusting immunosuppressive treatments for high-risk patients to reduce their chances of developing PTLD.

Currently, EBV screening rates vary across transplant centres in the US, and many do not routinely test for EBV after kidney transplants. If a patient develops PTLD, doctors typically lower immunosuppressive drug doses as a first step in treatment.

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