Epstein-Barr virus detection in sequential biopsies from patients with a posttransplant lymphoproliferative disorder

Sequential formalin-fixed, paraffin-embedded tissue biopsies from 10 patients with a posttransplant lymphoproliferative disorder (PTLD) were evaluated retrospectively for the presence of Epstein-Barr virus (EBV) DNA using the polymerase chain reaction (PCR). The patients included seven renal and two liver allograft recipients and one renal and cardiac allograft recipient. Sequential biopsies were available on every patient and pre-transplant biopsies in six patients. The EBV primers used amplify a 245-bp fragment of the EBV IR3 sequence and were run in parallel with human beta-globin gene primers. Nine patients (90%) had EBV detected during their posttransplant course: three at the time of diagnosis of the PTLD, and six from 15 to 121 days prior to diagnosis. Sites of presentation of the PTLD included liver (four), brain (two), native kidney (one), renal allograft (one), lymph node (one), and lung (one). Three patients died 61, 56, and 30 days posttransplantation, fourth at 198 days, and a fifth patient at 2 yr. All had clinical or histologic evidence of residual PTLD. In contrast, EBV DNA was detected in tissue from two of 29 "healthy" renal allograft recipients examined 2 to 16 mo posttransplantation. None of these patients has clinical evidence of a PTLD. We conclude that allograft biopsies provide a substrate for early detection of EBV by PCR, particularly when an atypical lymphoid infiltrate is encountered by light microscopy.