P8.067: Catastrophic EBV Infection After Cadaveric Kidney Transplantation

Introduction: We presented a catastrophic EBV infection after cadaveric kidney transplantation in this study. Method:Case: 42 years male patients,(unknown primary kidney disease, uneventful hemodialysis duration was 9 months) was transplanted kidney from cadaveric donors. The donor was 30 year old man with a history od Chron’s disease and multiple colonic surgery. ATG was used 5 days as a induction agent. Graft functioned immediately and well. Takrolimus, MMF and prednisolon were used for maintenance immunosuppression. Early posttransplant period was uneventful. The patient was discharged with good clinical condition and his creatinin level 1.9 mg/d in posttransplant 7th day. Results: He was admitted to hospital with dry cough and fever in the first month. Leukopenia was remarkable 2000/ mm3. Meropenem and G-CSF were was started with the diagnosis of febrile neutropenia. Blood and urine culture and CMV-DNA were negative. Splenomegaly was remarkable in his phisical examination. EBV-DNA was determined as a 314 000 copy/ml. While the preoperative EBV-IgG of the recipient was positive, there was no information about the donor. Thoracic and abdominal CT’s did not support the diagnosis of PTLD. PET-CT was normal because of persitan fever. The diagnosis of hemophagocytic lymphohistiocytosis associated with EBV reactivation by bone marrow biopsy was made. In addition, EBV-associated acute tubulointerstitial nephritis was detected in allograft biopsy. Aggressive treatment was initiated because of active EBV infection and related hemophagocytic lymphohistiocytic syndrome. While reducing immunosuppressive therapy, high dose dexametazone, etoposide and rituximab were administered according to HLH94 study. The EBV-DNA count, which rose to 768 000, dropped to 28 000, but after about 1.5 months, her breathing was disrupted and taken to intensive care. CMV infection was added to the clinical picture. Ganciclovir started. The patient did not respond to all treatment approaches and posttransplant died on day 96.Later, it was learned that the other recipient who had undergone kidney transplantation in other centers from the same cadaver died at 1 month and the liver recipient died at posttransplant 3rd day. EBV-DNA titers were high in both patients. Conclusions: As a result, EBV serology should be requested especially from cadaveric donor candidates who have received immunosuppressive treatment and have excessive comorbidity and donors with active infection should be excluded. We presented a catastrophic EBV infection after cadaveric kidney transplantation in this study.