Post-transplant Epstein-Barr virus-associated lymphoproliferative disorder after cardiac transplantation: a scoping review.

BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication following cardiac transplantation, frequently driven by Epstein-Barr virus (EBV) in the setting of chronic immunosuppression. Despite its clinical significance, data specific to adult cardiac transplant recipients remain fragmented, with variability in reported incidence, risk factors, and outcomes. METHODS: A scoping review was conducted using the Arksey and O'Malley framework and Joanna Briggs Institute guidelines. Five databases were searched for studies published between 2000 and 2025 focusing on EBV-associated PTLD in adult heart transplant recipients. Inclusion criteria encompassed observational and experimental studies conducted in the United States and Canada. Data extraction and screening were performed using Covidence, with study characteristics, incidence, risk factors, prevention strategies, and outcomes synthesized qualitatively. RESULTS: Six studies met inclusion criteria. PTLD incidence ranged from 0.83% to 5.1%, with 43% to 98% of cases associated with EBV. Donor-positive/recipient-negative EBV serologic mismatch and intensity of immunosuppression were the most consistent risk factors. Median time to PTLD diagnosis ranged from 3.6 to 4.4 years, though late-onset cases were reported. Preventive strategies included EBV PCR surveillance and modification of immunosuppressive regimens, particularly conversion to sirolimus-based therapy. Treatment approaches primarily involved reduction of immunosuppression, rituximab-based therapy, and chemotherapy, with variable outcomes and persistent high morbidity and mortality. CONCLUSION: EBV-associated PTLD remains a significant complication after cardiac transplantation. Risk stratification based on EBV serostatus and immunosuppression, along with standardized surveillance and tailored therapeutic strategies, is critical to improving outcomes in this high-risk population.