TITLE:
Everolimus Associated with Activated Vitamin D for Post-Transplant Increase Epstein-Barr-Virus Load Treatment. Two Case Reports
AUTHORS:
Luciano Moscarelli, Giulia Antognoli
KEYWORDS:
Calcitriol; Everolimus; Post-Transplant Lymphoproliferative Disease; Renal Transplant
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.3 No.7,
December
31,
2012
ABSTRACT: Post-transplant lymphoproliferative disease (PTLD) is an
uncommon but life-threatening complication of solid-organ and blood stem-cell
transplants. It is caused by an uncontrolled expansion of B lymphocytes
infected with Epstein-Barr virus (EBV). It responds poorly to therapy,
including reduction of immunosuppression, interferon, antivirals or chemotherapy.
Therefore the optimal
strategy for management is currently focused on prevention. Some centers have
already introduced chemoprophylaxis and/or preemptive strategies using EBV
viral load as a surveillance. Some experimental studies suggest that mTOR
inhibitors inhibits growth of human EBV-transformed B lymphocytes and vitamin D had an immune response to EBV. We report two cases of
an increased of blood BKV viral load after renal transplantation that were
successfully treated with everolimus in association with calcitriol. This
report suggests that everolimus associated with calcitriol could be an
effective and safe treatment for the prevention of PTLD in transplant
recipients.