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Transfusion-related Epstein-Barr virus infection among stem cell transplant recipients: a retrospective cohort study
Helen Trottier1, Chantal Buteau, Nancy Robitaille
1Department of Social and Preventive Medicine, University of Montreal, Sainte-Justine Hospital Research Centre, Montreal, Canada. helen.trottier@umontreal.ca
Insights
Transfusions may increase the risk of Epstein-Barr virus (EBV) infection after pediatric hematopoietic stem cell (HSC) transplants. This study found a link between blood product administration and EBV infection incidence in young HSC recipients.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Blood safety is critical to prevent pathogen transmission.
- Untested transfusion-transmitted infections, like Epstein-Barr virus (EBV), pose risks.
- EBV is linked to lymphoproliferative disease in transplant patients.
Purpose of the Study:
- To investigate the incidence of posttransplant EBV infection in pediatric hematopoietic stem cell (HSC) graft recipients.
- To determine the association between EBV infection and blood product administration in these patients.
Main Methods:
- Retrospective cohort study of pediatric HSC graft recipients.
- Analysis of pretransplant EBV serology in recipients and donors.
- Assessment of posttransplant EBV infection and transfusion history.
- Kaplan-Meier and Cox regression models used for incidence and association analysis.
Main Results:
- Pretransplant EBV seroprevalence was high in both recipients (77.9%) and donors (61.8%).
- Among seronegative recipients, 30- and 60-day cumulative EBV infection incidences were 4.6% and 13.4%.
- A positive trend was observed between transfusion volume and EBV infection.
Conclusions:
- Transfusions are associated with an increased risk of posttransplant EBV infection in HSC recipients.
- Further research may be warranted to confirm this association and explore preventative strategies.
Background:
Blood safety warrants strict screening measures to minimize the risk of transmitting blood-borne pathogens. However, transfusion-transmitted infections for which testing is not currently performed continue to be a concern. Among these untested agents is Epstein-Barr virus (EBV) which, in the transplant setting, is associated with lymphoproliferative disease, a potentially fatal cancer. The aim of this study was to analyze the incidence of posttransplant EBV infection and its association with administration of blood products in children receiving a hematopoietic stem cell (HSC) graft.
Study Design And Methods:
This retrospective cohort study sought to review charts of pediatric recipients of HSC grafts to collect information on the presence of EBV antibodies in the recipients' pretransplant sera and in HSC donor sera, incidence of posttransplant EBV infection, and patients' transfusion history. Cumulative incidence of posttransplant EBV infection was estimated by Kaplan-Meier methods according to pretransplant serology. The association between blood products and EBV infection was measured by Cox regression models.
Results:
The pretransplant EBV seroprevalence was 77.9% for recipients and 61.8% for graft donors. Virtually, all recipients received blood products during the peritransplant period. Among seronegative recipients, the 30- and 60-day cumulative incidences of posttransplant EBV infection were 4.6 (95% confidence interval [CI], 1.2-17.3) and 13.4% (95% CI, 5.8%-29.4%), respectively. The 60-day cumulative incidence was 8.3% (95% CI, 2.2%-29.4%) when restricting the analysis to seronegative recipients of cord blood grafts. Importantly, there was a clear positive trend associating EBV infection to transfusion volume.
Conclusion:
This study suggests an association between transfusions and posttransplant EBV infection in HSC transplant recipients.
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