Download EBV - ETCprotocols.org

Policy: Kidney/Pancreas Post Transplant: EBV Protocol
Statement: Vision Strategy: Patient Care
Policy Statement: The Emory Transplant Center and all the solid organ transplant programs will comply with all
applicable federal, state, and local laws, regulations, policies and protocols regarding the management of transplant
patients.
Basis: This protocol is necessary for the protection of patients, physicians and staff
Admin Responsibility: All transplant program physicians, practitioners and clinical staff members are responsible
for compliance with this clinical protocol.
Scope/Procedure:
Protocol:
1. All patients undergoing kidney (pancreas) transplantation will have the EBV status (antibody) rechecked at the
time of transplantation.
2. All patients will be informed of their donor/recipient EBV status and risk for EBV related disease by the posttransplant coordinator during the patient’s transplant admission and documented in OTTR and the appropriate
clinical transplant pathway.
3. D+/R - patients will be followed monthly by PCR for EBV at months 1 – 6, 9 and 12 post transplant. EBV PCR
testing will be discontinued after the 12 month draw unless clinically indicated and ordered by team clinical staff.
4. Response to EBV Viremia:
Upon detection if EBV PCR is < 1,000 copies it should be repeated in 2 weeks and in 1 month. If viremia is verified
on a subsequent measurement, but is still below 1,000 copies, then a 25% percent reduction (or as dictated by AUC
if performed) in the CNI dose should be instituted and a change in target range should be considered. EBV PCR
should then be monitored each month until a stable low level (<1,000) viremia is documented. (Probably
asymptomatic viremia).
If initial EBV PCR is > 5,000 copies then reduce dose of calcineurin inhibitor by 50% (or as dictated by AUC if
performed) and change target level to next lower level then repeat EBV PCR in 2-4 weeks.
If EBV PCR has greater than 50% reduction in level, continue to monitor every 2-4 weeks until PCR < 1,000 copies.
If EBV PCR has less than a 50% reduction in PCR then consider either a further reduction in the calcineurin
inhibitor dose or if the patient is already off the CNI, consider reduction of the anti-proliferative agent. Repeat EBV
PCR in 2-4 weeks and repeat cycle #4 until EBV PCR < 1,000 copies.
5. Selected patients treated for EBV infection may be referred for follow up in the Transplant ID Clinic.
6. If patient is diagnosed with PTLD consider discontinuation of calcineurin inhibitor and Hematology Consult must
be obtained
7. Policy Review:
As part of the QAPI program, policy compliance and CMV viremia rates for the first twelve months post transplant
will be reviewed every six months by the transplant program’s clinical leadership and transplant infectious disease
specialist.
References:
Approved by: Renal (Pancreas) Transplant Leadership Group
Signature on file____________________________
Thomas C. Pearson, MD, DPhil
Chair, Renal Transplant Leadership Group
Director, Renal and Pancreas Transplant Programs
Date Approved: 06.20.2007, 09.26.2007
Date Revised: 09.26.2007, 11.04.2009