Epstein-Barr virus triggered rejection after kidney allograft transplantation

Pediatric allograft recipients are at increased risk for Epstein-Barr virus (EBV)-associated disorders. We report on a 4-year-old boy who received a cadaver kidney transplant. The donor's viral status was not known. Twenty-one days after transplantation, serum creatinine and urea rose, giving evidence of transplant rejection. At this stage, EBV DNA in the recipient tested positive. The results of histological examination of the allograft kidney were interpreted as being EBV associated. For treatment of acute rejection immunosuppressive therapy was intensified. Finally, the renal transplant had to be explanted 46 days after implantation and peritoneal dialysis had to be restarted to compensate renal failure. In conclusion, EBV infection can lead to rapid rejection, and modification of immunosuppression does not necessarily improve allograft survival.