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Epstein-Barr virus (EBV) is an important potential cause of morbidity and mortality in children and adults undergoing solid organ (SOT) and hematopoietic stem cell transplantation (HSCT). The EBV virus is associated with a range of clinical symptoms and syndromes in both immunocompetent and immunocompromised patients based upon the virus’ ability to transform and immortalize B lymphocytes leading to viral-driven proliferation of infected B cells. In the immunocompetent host, this proliferation is primarily controlled by EBV-specific cytotoxic T lymphocytes (CTL). However, in the immunosuppressed SOT and HSCT recipient, impairment of the function of CTL can lead to unchecked proliferation and the development of EBV-associated posttransplant lymphoproliferative disorder (PTLD). In SOT recipients, the major risk factor for EBV-associated is being seronegative to the virus prior to and developing primary infection after the transplant, while in general SOT recipients who are EBV seropositive prior to transplant are at little risk for disease. For HSCT, the major risk factor relates to the EBV status and the potential T-cell depletion of the donor in an effort to minimize the risk of graftversus-host disease (GVHD). In both SOT and HSCT, adverse outcomes relating to EBV infection led to efforts to optimize treatment and to develop preventive strategies to mitigate the impact of this pathogen. This chapter will review epidemiology, diagnosis, treatment, and prevention of EBV disease including PTLD in SOT and HSCT recipients.

DOI: 10.1007/978-3-030-01751-4_27-1