Kidney Week

Abstract: SA-PO0688

Increased Incidence of Post-Transplant Lymphoproliferative Disorder and Epstein-Barr Virus DNAemia in Pediatric Kidney Transplant Recipients in the COVID-19 Era

Session Information

• Pediatric Nephrology: Transplantation, Hypertension, AKI, Genetics, and Developmental Diseases
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1900 Pediatric Nephrology

Authors

• Ashoor, Isa F, Boston Children's Hospital, Boston, Massachusetts, United States

Isa F Ashoor, MD

• Morey, JoAnn, Boston Children's Hospital, Boston, Massachusetts, United States

JoAnn Morey

• D'Ambrosi, Gabrielle, Boston Children's Hospital, Boston, Massachusetts, United States

Gabrielle D'Ambrosi, MPH

• Somers, Michael J., Boston Children's Hospital, Boston, Massachusetts, United States

Michael J. Somers, MD

Background

Primary Epstein Barr Virus (EBV) infection after kidney transplant (KT) is a major risk factor for post transplant lymphoproliferative disorder (PTLD). Recent observations suggest a compounding effect of COVID-19 infection on the incidence of other viral infections. We examined EBV DNAemia and PTLD incidence in pediatric KT recipients in temporal association to the COVID pandemic.

Methods

All KT recipients transplanted at a single pediatric center from 2015-2023 with at least 1 year (yr) of follow-up were included. EBV DNAemia was defined as a positive EBV DNA PCR test anytime in the 1st yr post KT. Baseline demographics and outcomes of interest (EBV DNA PCR result in 1st yr and occurrence of PTLD as of last follow-up) were collected. Exposure of interest was whether the KT clinical course was in the COVID era (on or after 3/1/2020) or pre-COVID (before 3/1/2020). COVID era was modeled as a time-dynamic exposure varying each day after the patient’s KT in relation to 3/1/2020. We fit a cox proportional hazards regression model to examine the association between EBV DNAemia in the 1st yr post KT and COVID era.

Results

212 KT recipients were included (mean age 10.8 years; 52% deceased donation; 91.5% intermediate/high risk for EBV infection). 89% received depletional induction therapy and 84% steroid avoidance maintenance immunosuppression. There were no differences in clinical characteristics across the COVID eras. Among all, 27% developed EBV DNAemia in the 1st yr post KT. In those whose 1^st yr post-Tx overlapped any time in the COVID era, the rate of EBV DNAemia was 1.88 times (95% CI 1.12 to 3.17, p-value 0.018) the rate among those without a 1^st yr in the COVID era. The overall incidence of PTLD was 2.7 cases per 10 person-yrs, with COVID era incidence significantly higher compared to pre-COVID (9.3 vs. 1.8 cases per 10 person yrs; incidence rate ratio 5.1 [95% CI 1.8-14.2, p-value 0.002).

Conclusion

In this large pediatric cohort of KT recipients, we observed significantly increased PTLD incidence in the initial COVID era that mirrored increased incidence of EBV DNAemia during this same time. Further exploration of the impact of acquired COVID immunity on rates of EBV DNAemia and PTLD post-Tx may offer additional insight into both risk and mitigation strategy.

Funding

• Clinical Revenue Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.202572j7s9fg