Abstract
Contemporary Outcomes of ATG Induced Pediatric Heart Recipients with Serological EBV Mismatch
The Journal of heart and lung transplantation, v 45(5), pp 705-706
Jul 2026
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Abstract
Purpose: Ebstein Bar Virus (EBV) viremia is a significant risk factor for post-transplant lymphoproliferative disorder (PTLD) in pediatric heart transplant recipients. Evidence regarding the impact of Anti-Thymocyte Globulin (ATG) induction on EBV-related outcomes remains conflicted. This study aims to clarify whether donor or recipient EBV serostatus confers greater risk of PTLD and mortality in contemporary pediatric heart transplant (HT) recipients.
Methods: The United Network for Organ Sharing (UNOS) database was queried for pediatric HT recipients with recipient/donor EBV serotype mismatch who received ATG induction from June 2020 to June 2023. Multi-organ and re-transplant patients were excluded. Patients were stratified based on serostatus mismatch (R+/D- vs R-/D+) with a primary endpoint of Kaplan-Meier 3-year survival. Donor and recipient characteristics alongside perioperative outcomes were assessed. Categorical and continuous variables were compared using Chi-Squared and t-test, respectively. All p-values were two-sided tests with p<.05 indicating significance and analyses are reported as (R+/D-%, R-/D+%, p-value).
Results: A total of 444 recipients were analyzed with 133 R+/D- and 311 R-/D+ EBV serotypes. R+/D- recipients were younger (5 vs 8, p<0.001) with lower rates of LVAD (28% vs 42%, P=0.004) and ventilator use (5% vs 12%, p=0.01) at transplant. After transplant, R-/D+ recipients had significantly higher rates of PTLD diagnosis (2% vs 7%, p=0.02). The remaining perioperative variables were non-significant with similar rates of acute rejection (10% vs 7%, p=0.40), malignancy cause of death (0% vs 1%, p=0.47), and 3-year mortality (92% vs 89%, p=0.21).
Conclusion: In ATG induced, EBV mismatched transplants, donor positive serostatus carries an increased risk of PTLD. However, other perioperative variables and outcomes data suggests that this increase does not translate to inferior mortality. Increased PTLD surveillance should be considered with R-/D+ transplant recipients.
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Details
- Title
- Contemporary Outcomes of ATG Induced Pediatric Heart Recipients with Serological EBV Mismatch
- Creators
- J. White - University of California, Los AngelesJ. Song - University of California, Los AngelesH. Zappacosta - University of California, Los AngelesP Cho - Drexel University, College of MedicineS. McKay - University of California, Los AngelesA. Abramov - University of California, Los AngelesM. Daniel - University of California, Los AngelesD. Telesca - University of California, Los AngelesA. Ardehali - University of California, Los AngelesM. Husain - University of California, Los Angeles
- Publication Details
- The Journal of heart and lung transplantation, v 45(5), pp 705-706
- Conference
- 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT), 46th (Toronto, Ontario, Canada, 22 Apr 2026–26 Apr 2026)
- Publisher
- Elsevier Inc
- Number of pages
- 2
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001761683000060
- Other Identifier
- 991022189168704721