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The diagnostic and therapeutic dilemma of the co-existence of BK virus nephropathy with acute rejection - an experience from a single Centre and review of the literature.
- Source :
-
Transplant immunology [Transpl Immunol] 2022 Jun; Vol. 72, pp. 101581. Date of Electronic Publication: 2022 Mar 14. - Publication Year :
- 2022
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Abstract
- Introduction: BKV nephropathy (BKVN) is one of the major causes of graft loss with the advent of potent immunosuppressive drugs. The literature on the co-existence of acute rejection (AR) and BKVN is scarce.<br />Materials and Methods: This is a single-center retrospective analysis, where the allograft biopsies of patients transplanted between 2011 and 2021 were reviewed. The biopsies, which showed evidence of coexistent AR and BKVN, were included. In addition, demographic profiles, clinical presentation, treatment details, response to therapy, and follow-up were analyzed.<br />Results: Out of 1175 live transplants done between January 2011 and March 2021, 49 had BKVN representing 4.17%. Only seven patients (0.59%) had coexistent BKVN with AR. The mean serum creatinine at presentation was 2.3 mg/dl. The mean duration to diagnosis from transplant was seven months (range 3-22 months). All had significant viremia at presentation (17450-4,750,000 copies/ml). All biopsies showed type 1 inclusion bodies with SV40 positivity except one. Coexistent acute T cell-mediated rejection (TCMR) was found in five and acute ABMR in two patients. Three patients received pulse IV methylprednisolone, five received 2 g/kg IVIG, two received plasma exchange as upfront therapies. Maintenance immunosuppression reduction was made in all. Viremia clearance was noted at a mean duration of 3.5 months. However, three patients lost their grafts on follow-up. Four had stable graft function with a mean serum creatinine of 1.54 mg/dl.<br />Conclusion: Intensifying immunosuppression to treat AR followed by a reduction in maintenance immunosuppression and IVIG and antiviral therapies seems better strategy and showed good long-term graft survival in patients with coexistent BKVN and AR.<br /> (Copyright © 2022 Elsevier B.V. All rights reserved.)
- Subjects :
- Creatinine
Graft Rejection diagnosis
Humans
Immunoglobulins, Intravenous therapeutic use
Retrospective Studies
Viremia diagnosis
BK Virus
Kidney Diseases
Kidney Transplantation adverse effects
Nephritis, Interstitial
Polyomavirus Infections complications
Polyomavirus Infections diagnosis
Polyomavirus Infections therapy
Tumor Virus Infections diagnosis
Tumor Virus Infections therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1878-5492
- Volume :
- 72
- Database :
- MEDLINE
- Journal :
- Transplant immunology
- Publication Type :
- Academic Journal
- Accession number :
- 35301106
- Full Text :
- https://doi.org/10.1016/j.trim.2022.101581