ABSTRACT
Figure 1 Actuarial survival according to duration of passive prophylaxis with anti-HBsAg immunoglobulin. Survival in the group given long-term therapy was significantly better than in either of the other groups (P < .001). Values in parentheses denote numbers of patients. (From Ref. 47 with permission of 'I"M New Englllnd JourTII.ll of M~diciM. Samuel et al. Liver transplantation in European patients with the hepatitis B surface antigen. N Engl J Med 1993; 329:18421847. Copyright 1993, Massachusetts Medical Society.)
PREVENTION OR TREATMENT OF POSTTRANSPLANT l YMPHOPROLIFERATIVE DISORDER
The therapy of EBV-associated PTLD is generally disappointing, and there are no prospective or controlled trials evaluating different treatment regimens for this disease. For established PTLD, immunosuppressive therapy is usually reduced, antiviral agents are often employed, and radiotherapy or cytotoxic chemotherapy is utilized in select cases (53). An intriguing use for immunoglobulins in solid organ transplantation would be for the prevention or treatment of PTLD. A situation analogous to PTLD occurs in a rare but fatal congenital disease associated with male phenotypic expression, known as Duncan's syndrome (54). These individuals have a selective immunodeficiency that renders them susceptible to fatal infectious mononucleosis occasionally accompanied by acquired agammaglobulinemia or progression to lymphoma (55). The use of monthly IV immunoglobulins, which contain antibody to the EBV viral capsid antigen, has been generally successful in preventing disease in these kindreds (56). The use of such a strategy in preventing PTLD, especially in transplant recipients at risk for primary EBV infection, may warrant clinical investigation. In addition, an anecdotal report using combination treatment consisting of immunoglobulin plus a-interferon suggests a role for the use of immunoglobulins in the treatment of established EBV -associated PTLD (57). An additional report noted the effectiveness of CMVIG and ganciclovir for the treatment of EBV-associated disease in a renal transplant recipient (58). Of interest,
