P-2275. Impact of Epstein-Barr Virus (EBV) Donor Serostatus on Post-transplant Mortality and Post-Transplant Lymphoproliferative Disorder in Thoracic Organ Transplant EBV-Seropositive Recipients: Data from the Organ Procurement and Transplantation Network
Bibliographic record
Abstract
Abstract Background Epstein Barr Virus (EBV) donor positive (D+) serostatus is a risk factor for Post-Transplant Lymphoproliferative Disorder (PTLD) in EBV-seronegative recipients. The impact of donor EBV serostatus on mortality and PTLD in EBV-seropositive recipients (R+) in thoracic organ transplant (TOT) is unknown.Table 1.Baseline demographic and clinical characteristics of EBV D-/R+ and EBV D+/R+ TOT recipients Methods Using the Organ Procurement and Transplantation Network database, we identified 47,201 EBV R+ TOT recipients between 01/2004 – 12/2021. The primary exposure was EBV D+ and the primary outcomes were death and PTLD. Multivariable Cox regression models were used to assess the relationship between donor EBV serostatus and the outcome of death and PTLD.Figure 1.Kaplan-Meier survival plots for EBV D-/R+ (solid line) versus EBV D+/R+ (dashed line) post heart (red line) and lung (blue line) transplantation Results Of 47,201 EBV R+ TOT recipients, 48.5% were lung and 51% were heart transplant recipients. The majority (93.4%) were EBV D+/R+, with median age of 59 years and 66.8% males. EBV D-/R+ and D+/R+ TOT recipients differed in CMV donor and recipient status, donor median age, sex, and graft failure (Table 1). The incidence rate of death was 7.2 per 100 person-years in EBV D+/R+ compared to 6.9 per 100 person-years in EBV D-/R+, p=0.156. Survival did not differ by EBV donor status, but it was lower in lung transplant (Figure 1). The incidence rate of PTLD was 0.26 per 100-person years in EBV D+/R+ compared to 0.33 per 100-person years in EBV D-/R+, p= 0.073. EBV D+ status was not associated with increased hazard of death in both univariable (crude hazard ratio [HR] of 1.05; confidence interval [CI], 0.98-1.11; p=0.15) and multivariable analyses (adjusted HR of 0.96; 95% CI, 0.90-1.02; p=0.14), after controlling for donor age, CMV D+ status, and the following recipient factors: age, sex, race, insurance, pre-transplant life support, pre-transplant malignancy, rejection, and graft failure. EBV D+ status was associated with decreased hazard of PTLD when adjusting for recipient age and graft failure (adjusted HR of 0.74; 95% CI, 0.56-0.98; p=0.03). In subgroup analyses by organ, EBV D+ status was associated with decreased hazard of PTLD in lung (adjusted HR of 0.56; 95% CI, 0.40-0.78; p=0.001) but not in heart transplant recipients (adjusted HR of 1.18; 95% CI, 0.71-1.96; p =0.50) (Figure 2).Figure 2.Kaplan-Meier PTLD-free survival plots for EBV D-/R+ (solid line) versus EBV D+/R+ (dashed line) post heart (red line) and lung (blue line) transplantation Conclusion Among EBV-seropositive TOT recipients, EBV D- status may be associated with increased risk of PTLD, particularly in lung transplant recipients. Disclosures Alissa J. Inc, MD, MSc, Takeda: Honoraria Sara Belga, MD, MPH, Takeda, Moderna, AstraZeneca, GSK: Advisor/Consultant|Takeda, Moderna, AstraZeneca, GSK: Grant/Research Support|Takeda, Moderna, AstraZeneca, GSK: Honoraria
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.040 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".