Polyomavirus in kidney and kidney‐‐pancreas transplant recipients

Abstract

Polyomavirus nephritis may be increasing in incidence and appears to be unresponsive to either conventional antiviral agents or a reduction in immunosuppression. Most of our cases occurred in male diabetic patients undergoing cadaveric donor transplantation and were preceded by biopsy-proven nephrotoxicity. Further studies are needed to better define the pathogenesis of PV and effective antiviral treatment.

Kidney Transplant Function and Histological Clearance of Virus Following Diagnosis of Polyomavirus-Associated Nephropathy (PVAN)

“…The potential for PVAN to result in very high rates of graft loss is well documented (1)(2)(3)11 (31)(32)(33)(34). Among the published series, the occurrence of lesser degrees of functional loss has not been examined.…”

“…Although subsequent acute rejection may occur in 10% to 30% of cases (2,3), reports of patients in whom immunosuppression was unchanged or increased indicate very poor outcomes (3,35). Individual protocols for reducing immunosuppression have not been directly compared.…”

“…Evidence that such interventions accelerate clearance of BKV from the graft or protect against further loss of graft function compared to immunosuppression reduction alone is tenuous, being based on uncontrolled case series. In general, few published studies have quantified the impact of biopsyproven PVAN on graft function from the time of diagnosis under one or more therapeutic strategies (2,(4)(5)(6)(7). We present here an outcome analysis involving a substantial cohort of PVAN cases which clarifies the impact of baseline characteristics as well as of specific treatment strategies on functional trends during the first several years following diagnosis.…”

“…Polyomavirus-associated interstitial nephropathy (PVAN) due to BK virus (BKV) reactivation has emerged as an important cause for kidney transplant (KTx) failure (1)(2)(3)(4)(5)(6)(7)(8). Viral reactivation in the urinary tract and in the transplanted kidney is a direct result of the immunosuppressed state and may involve donor-and/or recipient-derived virus (5)(6)(7)9,10).…”

BK Virus Infection in Renal Allograft Recipients

“…Additional recipient risk factors that have been identified are a history of diabetes, older age and male gender [1,17,35,36]. Transplant surgery associated variables such as delayed graft function (DGF), ischemia, deceased donor grafts and use of ureteral stents have also been identified as risk factors for BKV viremia/nephropathy [1,37,38].…”