Epstein Barr Virus Quantitative Polymerase Chain Reaction Monitoring in Lung and Bone Marrow Transplant Patients to Predict Post-Transplant Lymphoproliferative Disorder: A Systematic Review

Background

Epstein–Barr virus (EBV)-driven post-transplant lymphoproliferative disorder (PTLD) affects up to 10% of lung transplant patients and is associated with high morbidity and mortality. Early identification of patients at risk of PTLD and reduction in immunosuppression may be an effective way to prevent future diseases.

Methods

A systematic review was conducted of all bone marrow (BMT/HSCT) and lung transplant studies published in English that assessed quantitative peripheral blood EBV PCR monitoring as a predictive measure of future PTLD occurrence. Studies on pre-emptive therapy before the diagnosis of PTLD were excluded.

Results

A thousand of hundred sixty-three studies were screened, and 12 were eligible for the final analysis. The two lung transplant studies reported 60% to 80% sensitivity (SN) and 60% to 86% negative predictive value (NPV), but poor specificity (SP) (30%-75%) and positive predictive value (PPV) (30%-67%). HSCT studies also showed good SN (71.4%-100%) and NPV (94%-100%). However, the SP (range, 50%-96%) and PPV (range, 14%-75%) were poor. The included studies used nonstandardized EBV PCR testing methods, which affected the validity of the results and the applicability of the findings to other transplant programs. Most studies were retrospective and included a small number of cases.

Conclusions

In conclusion, this systematic review demonstrated the lack of good-quality evidence and poor SP and PPV of EBV PCR monitoring to predict PTLD development in lung transplantation. The use of PCR-guided preemptive therapy for future PTLD prevention is questionable. Further studies with standardized EBV PCR measurements are required.