Positive EBV Viral Capsid Antigen IgG and Living Kidney Donation
A positive Epstein-Barr Virus (EBV) Viral Capsid Antigen IgG does not disqualify someone from being a living kidney donor, as EBV seropositivity is extremely common in the adult population and is part of standard infectious disease screening for all potential donors. 1, 2
Standard Infectious Disease Screening for Living Kidney Donors
- All potential living kidney donors must undergo comprehensive infectious disease screening, including testing for EBV, CMV, HIV, HBV, HCV, and syphilis 1, 3
- EBV testing is specifically included in the standard screening panel recommended by the American Journal of Kidney Diseases 2
- Testing should be performed or updated within 28 days of donation to ensure accuracy 1
Interpretation of Positive EBV VCA IgG Results
- A positive EBV VCA IgG indicates past infection and immunity, which is extremely common in the adult population 4
- In some regions like Iran, studies have shown 100% EBV seroprevalence among potential kidney donors and recipients over age 18 4
- EBV seropositivity alone is not a contraindication to donation and is actually preferable in many cases 5
EBV Serostatus Matching Considerations
- The donor-recipient EBV serostatus match is more important than the donor's serostatus alone 5
- High-risk EBV mismatches occur when an EBV-positive donor donates to an EBV-negative recipient, which can lead to primary infection in the immunosuppressed recipient 5, 6
- A positive EBV VCA IgG in both donor and recipient (D+/R+) is considered a low-risk combination 6
- Only the rare D+/R- combination (positive donor to negative recipient) presents higher risk for primary EBV infection post-transplant 6
Risk Assessment Framework
- If a donor candidate is found to have any potentially transmissible infection, the transplant team should weigh the risks and benefits of proceeding with donation 1
- For EBV specifically, the presence of IgG antibodies alone represents past infection rather than active infection and does not typically prevent donation 2
- The transplant team must evaluate the complete infectious disease profile of both donor and recipient to make appropriate decisions 3
Common Pitfalls to Avoid
- Failing to distinguish between past infection (IgG positive) and active infection (IgM positive) can lead to unnecessary exclusion of potential donors 6
- Not considering the recipient's EBV serostatus when evaluating donor candidacy may miss opportunities to prevent high-risk mismatches 5
- Overlooking the importance of testing timing (within 28 days of donation) can lead to inaccurate risk assessment 1
In conclusion, a positive EBV VCA IgG result indicates past infection and immunity, which is extremely common in adults and does not disqualify someone from being a living kidney donor. The donor-recipient EBV serostatus match is more important than the donor's status alone, with D+/R+ combinations being low-risk for complications.