Increased EBV DNAemia after Anti-SARS-CoV-2 Vaccination in Solid Organ Transplants

Abstract

The reactivation of latent viruses during SARS-CoV-2 infection is well recognized, and coinfection with Epstein−Barr virus (EBV) has been associated with severe clinical cases of COVID-19 infection. In transplant patients, EBV infection presents a significant challenge. Assessing the potential impact of SARS-CoV-2 vaccinations on EBV infections in stable kidney and liver transplant recipients was the objective of our study. Ten solid-organ-transplant (SOT) patients (eight kidney and two liver) vaccinated with standard doses of mRNA COVID-19 vaccines were included. EBV DNA viral load measurements were conducted prior to the vaccination and during a follow-up period (at the first month and after six months) after the second vaccine dose. After the second dose, a significant increase in median viremia was observed (p < 0.01) in 9 patients, and in one patient, the reactivation of EBV infection was found. Six months later, the median viremia decreased significantly (p < 0.05). The EBV viral load should be closely monitored as it could lead to the earlier diagnosis and treatment of EBV-related complications. Despite experiencing a decrease in the viral load six months post-vaccination, some patients still had a viral load over the baseline, which increased the risk of potential complications.

Keywords: COVID-19; Epstein–Barr virus; solid organ transplant; vaccine.

Figure 1

Median, minimum, maximum, and interquartile ranges of EBV viremia before the vaccination and after the second dose of SARS-CoV-2 vaccine in transplant patients.

Figure 2

The individual results of the Epstein–Barr virus (EBV) viremia during the follow-up period (The individual symbols mark the next patients and the dashed line marks the results of the patient who reactivated EBV infection).