Current Insights into Epstein - Barr virus Prevalence and Clinical Impact among Kidney Transplant Recipients in Iraq: An Updated Review

Background: Epstein–Barr virus (EBV) is a major concern in kidney transplantation, contributing to post-transplant lymphoproliferative disorder (PTLD), graft dysfunction, and allograft loss. In Iraq, data on EBV prevalence among kidney transplant recipients (KTRs) are scarce, with most evidence derived from hemodialysis patients.


Objective: To systematically review the prevalence and clinical impact of EBV in Iraqi KTRs and assess associated risk factors, diagnostic approaches, and management strategies.


Methods: A systematic search of PubMed, Scopus, Web of Science, Google Scholar, and Iraqi repositories was conducted. Eligible studies on EBV prevalence and outcomes in KTRs and hemodialysis were screened, appraised, and synthesized following PRISMA guidelines.


Results: Available Iraqi studies indicate variable EBV prevalence in KTRs and hemodialysis, with risk factors including intensive immunosuppression, lymphocyte-depleting therapies, donor and graft characteristics, co-infections, recipient age, and post-transplant timing. Diagnostic strategies reported include donor-recipient serostatus, quantitative EBV PCR, and histopathology. Emerging therapeutic options, particularly EBV-specific adoptive T-cell therapy, show promise in reducing reactivation and preserving graft function.


Conclusion: EBV poses a significant but understudied risk in Iraqi KTRs. Consolidating regional evidence with international insights highlights the urgent need for targeted EBV surveillance and management strategies to improve transplant outcomes in Iraq.