Anemia as a Complication of Parvovirus B19 Infection in Renal Transplant Recipients

Abstract

Background. The frequency of B19 infection in renal transplant donors and recipients was studied to determine the significance of active viral infection in the development of anemia. Material and Methods. Serum, plasma, and peripheral blood leukocyte samples of 47 renal transplant donors, 38 recipients with anemia (Group 1), and 25 without anemia (Group 2) after renal transplantation were evaluated for the presence of anti-B19 specific antibodies (ELISA) and B19 DNA (nPCR). Results. Active persistent B19 infection after renal transplantation was detected in 12 of the 38 in the Group 1 (10 had reactivation and 2 primary infection), and none of the recipients in the Group 2 had it. Of the 12 recipients in the Group 1, 10 were seropositive and 2 seronegative before renal transplantation; 10 received the transplants from the seropositive and 2 from seronegative donors. rHuEPO therapy-resistant severe anemia was detected only in the recipients with active B19 infection after renal transplantation in the Group 1 (7/12). The logistic regression analysis revealed a significant relationship between active B19 infection and severe anemia (OR, 0.039; 95% CI, 0.006–0.257; P=0.001). Conclusions. Active B19 infection was documented only in the anemic recipients and could be associated with the development of severe anemia after renal transplantation. This allows us to recommend concurrent screening for viral DNA in plasma and detection of anti-B19 IgM class antibodies. To find the association between B19 infection and the development of anemia, further investigations are necessary.

Risk factors and long‐term outcomes of parvovirus B19 infection in kidney transplant patients

“…A few studies have analyzed risk factors for parvovirus B19 infection . Carpenko et al . identified 12 patients with active parvovirus B19 infection among 38 KTRs with anemia and compared them with KTRs without anemia.…”

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

“…Immunosuppressive agents, antihypertensive agents (angiotensin-converting enzyme inhibitors, e.g., angiotensin-converting enzyme; angiotensin-receptor blockers, e.g., ARB), iron deficiency, hemolysis, and malignant tumors also result in anemia. Among infections, parvovirus B19 causes post-transplantation pure red cell aplasia [256]. Among immunosuppressive agents, inhibitors of nucleic acid synthesis (e.g., mycophenolate mofetil, azathioprine, mizoribine) are particular causes of bone marrow suppression throughout the post-transplant course [247].…”

Modeling the parvovirus B19 blood safety risk in Australia

“…The frequency of B19V‐attributable anemia in kidney transplant recipients represents the rate of B19V‐attributable anemia or cytopenia and can be extrapolated to other solid organ transplant (SOT) recipients. It was unclear what this rate may be because few studies were available; therefore, risk was estimated for three values: 10%, 50%, and the intermediate value of 30%. The burden of B19V‐associated complications is much lower for hematopoietic stem cell transplant than SOT recipients . The specific rate is unclear; therefore, risk was estimated for three values: 1%, 5%, and 10%. The number of red blood cells (RBCs) transfused to patients with hereditary hemolytic anemias (HHAs) per year is approximately equal to national hospital separations for these conditions with equivalent RBC use patterns to those reported in a 2011 South Australian study …”