Incidence and clinical significance of human parvovirus B19 infection in kidney transplant recipients

Abstract

Human parvovirus B19 (B19) infection has been known to cause chronic anemia, pure red cell aplasia (PRCA), glomerulopathy, and allograft dysfunction in kidney transplant (KT) recipients. The aim of this study was to evaluate the incidence and clinical significance of B19 infection in KT recipients. A total of 537 serum samples from 167 KT recipients were included in the present study. The incidence of B19 infection was based on either qualitative polymerase chain reaction (PCR) or quantitative PCR with LightCycler Parvovirus B19 Quantitation kit. Clinical significance of B19 infection was investigated by a retrospective review of hemoglobin (Hb) levels and the results of kidney and bone marrow biopsies. The overall PCR positive rate was 18.3% (98/537), and 52 of 167 (31.1%) KT recipients showed at least one positive PCR. In addition, 20 of 167 subjects (12.0%) showed PCR-positivity more than two consecutive times, and they had significantly lower Hb levels than those with negative or one positive PCR (p < 0.0001). Furthermore, two patients suffered from PRCA, which was confirmed by bone marrow biopsy. However, B19 infection did not seem to affect the graft outcome. In conclusion, the B19 infection in KT recipients was not uncommon and was associated with low Hb levels and PRCA after KT.

Parvovirus B19 Infection after Transplantation: A Review of 98 Cases

“…The preponderance of case reports and the relative lack of large case series imply that PVB19 infection is rarely encountered after transplantation. However, recent studies using molecular surveillance have challenged this view by demonstrating PVB19 DNA in the blood of 23%-31% of kidney transplant recipients, particularly those with anemia [8,9]. Because anemia is a common complication after transplantation, and because PVB19 surveillance is not performed in clinical practice, it is possible that the magnitude of PVB19 infection is underestimated.…”

Parvovirus B19 and the Kidney

“…Furthermore, interpretation is difficult given different selection criteria, diagnostic methods with different detection sensitivities, different definitions of infection, and various (but limited) lengths of follow-up, together with confounding by concurrent viral epidemics (80). Nevertheless, on the basis of several longitudinal studies, between 1 and 12% of unselected, mainly adult, renal transplant recipients have symptomatic B19 infection during the first year after transplantation (79 -81).…”

Postrenal Transplant Hemophagocytic Lymphohistiocytosis and Thrombotic Microangiopathy Associated with Parvovirus B19 Infection

“…In renal transplant recipients, B19 infection may enter the body via the respiratory tree or transplanted organ, or may be reactivated from a latent infection (6). This infection is associated with refractory and recurrent anemia, glumerulopathy, proteinuria, microscopic vasculitis, thrombotic microangiopathy (TMA), hepatitis and severe encephalitis in renal transplant recipients (7)(8)(9)(10)(11)(12)(13). Herein, we report a renal transplant recipient with severe anemia, allograft dysfunction, TMA and HLH two years following transplantation.…”