Use of intravenous immunoglobulin in a highly sensitized pediatric renal transplant recipient with severe BK DNAemia and rising DSA

Piburn, Kim H; Al-Akash, Samhar

doi:10.1111/petr.13600

Cited by 8 publications

(10 citation statements)

References 16 publications

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“…Due to its immunomodulatory properties, IVIG has been postulated to prevent development of alloimmunity during reduced immunosuppression [43–49]. However, we could not observe a risk reduction with respect to development of TCMR, de novo DSA and ABMR.…”

Section: Discussioncontrasting

confidence: 77%

Intravenous immunoglobulins do not prove beneficial to reduce alloimmunity among kidney transplant recipients with BKV‐associated nephropathy

et al. 2021

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Summary Reduced immunosuppression during BKV‐DNAemia has been associated with T‐cell mediated rejection (TCMR), de novo donor‐specific antibodies (DSA) and antibody‐mediated rejection (ABMR). Intravenous immunoglobulins (IVIG) may reduce alloimmunity. We studied 860 kidney transplant recipients (KTRs) for the development of BKV‐DNAuria and BKV‐DNAemia (low‐level <10 000 IE/ml, high‐level >10 000 IE/ml). 52/131 KTRs with high‐level BKV‐DNAemia received IVIG. The HLA‐related immunological risk was stratified by the Predicted Indirectly Recognizable HLA Epitopes (PIRCHE) algorithm. BKV‐DNAuria only was observed in 86 KTRs (10.0%), low‐level BKV‐DNAemia in 180 KTRs (20.9%) and high‐level BKV‐DNAemia in 131 KTRs (15.2%). KTRs with low‐level BKV‐DNAemia showed significantly less TCMR compared to KTRs with high‐level BKV‐DNAemia (5.2% vs. 25.5%; P < 0.001) and no BKV‐replication (13.2%; P = 0.014), lowest rates of de novo DSA (21.3%), ABMR (9.2%) and flattest glomerular filtration rate (GFR) slope (−0.8 ml/min). KTRs with low‐level BKV‐DNAemia showed significantly higher median (interquartile range) total PIRCHE if they developed TCMR [100.22 (72.6) vs. 69.52 (49.97); P = 0.020] or ABMR [128.86 (52.99) vs. 69.52 (49.96); P = 0.005]. Administration of IVIG did not shorten duration of BKV‐DNAemia (P = 0.798) or reduce TCMR, de novo DSA and ABMR (P > 0.05). KTRs with low‐level BKV‐DNAemia showed best protection against alloimmunity, with a high number of PIRCHE co‐determining the remaining risk. The administration of IVIG, however, was not beneficial in reducing alloimmunity.

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Section: Discussioncontrasting

confidence: 77%

Intravenous immunoglobulins do not prove beneficial to reduce alloimmunity among kidney transplant recipients with BKV‐associated nephropathy

et al. 2021

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“…In addition, several medical treatments have been tried, including intravenous immunoglobulin [105,106], cidofovir [107,108], and fluoroquinolone [109]. Intravenous immunoglobulin through osmotic injury causes vacuolation in proximal tubular epithelial cells, in turn leading to acute kidney injury [110].…”

Section: Therapeutic Optionsmentioning

confidence: 99%

BK Virus-Associated Nephropathy after Renal Transplantation

Funahashi

2021

Pathogens

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Recent advances in immunosuppressive therapy have reduced the incidence of acute rejection and improved renal transplantation outcomes. Meanwhile, nephropathy caused by BK virus has become an important cause of acute or chronic graft dysfunction. The usual progression of infection begins with BK viruria and progresses to BK viremia, leading to BK virus associated nephropathy. To detect early signs of BK virus proliferation before the development of nephropathy, several screening tests are used including urinary cytology and urinary and plasma PCR. A definitive diagnosis of BK virus associated nephropathy can be achieved only histologically, typically by detecting tubulointerstitial inflammation associated with basophilic intranuclear inclusions in tubular and/or Bowman’s epithelial cells, in addition to immunostaining with anti-Simian virus 40 large T-antigen. Several pathological classifications have been proposed to categorize the severity of the disease to allow treatment strategies to be determined and treatment success to be predicted. Since no specific drugs that directly suppress the proliferation of BKV are available, the main therapeutic approach is the reduction of immunosuppressive drugs. The diagnosis of subsequent acute rejection, the definition of remission, the protocol of resuming immunosuppression, and long-term follow-up remain controversial.

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“…In addition, several medical treatments have been tried, including intravenous immunoglobulin ( Piburn and Al-Akash, 2020 ), cidofovir ( Kuten et al, 2014 ), and fluoroquinolone ( Gabardi et al, 2010 ). Cidofovir (Vistide®, Gilead, Foster City, CA, USA), is an intravenously administered nucleoside analog of deoxycytidine monophosphate that is licensed by the U.S. Food & Drug Administration for the treatment of cytomegalovirus (CMV) retinitis in AIDS patients.…”

Section: Polyomavirusmentioning

confidence: 99%