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Mohammad D, Kim DY, Baracco R, Kapur G, Jain A. Treatment of BK virus with a stepwise immunosuppression reduction and intravenous immunoglobulin in pediatric kidney transplant. Pediatr Transplant 2022; 26:e14241. [PMID: 35122460 DOI: 10.1111/petr.14241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/04/2021] [Accepted: 01/14/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND BKV and BKVN are common in pediatric kidney transplant, but there is limited data on treatment approaches. Our objective was to study the prevalence of BKV and BKVN utilizing only plasma qPCR and report treatment outcomes with stepwise IR and IVIG. METHODS A retrospective study of all pediatric kidney transplants from 2013 to 2020. Excluded patients >21 years at transplant and immediate graft failure. Surveillance was conducted using only plasma BK qPCR at 1, 3, 6, 9, 12, 18, and 24 months and annually. BKV defined as ≥250 copies/ml and resolution as <250 copies/ml. Presumed BKVN as >10 000 copies/ml despite IR; and BKVN if confirmed on histology. RESULTS Fifty-six patients were included in the study; 20 (35.7%) had BKV. BKV was associated with longer duration of stent, 40 vs. 33.5 days (p = .004). Two patients (3.5%) had confirmed, and 2(3.5%) had presumed BKVN. The first-line treatment was IR in 100% of patients. BKVN confirmed and presumed received IVIG every month for six doses. Viral resolution was achieved in 70%, and no difference was noted in estimated glomerular filtration rate between BKV and non-BKV group (p = .438). There were no rejection episodes, and graft survival was 100% over median follow-up of 3 years. CONCLUSIONS Plasma qPCR alone is adequate for screening and monitoring treatment of BKV and BKVN. A stepwise IR and IVIG resulted in BKV resolution in the majority of patients. Larger studies are required to study the role of IVIG in the treatment of BKVN.
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Affiliation(s)
- Dunya Mohammad
- Division of Pediatrics, Children's and Women's Hospital, University of South Alabama, Mobile, Alabama, USA
| | - Dean Y Kim
- Division of Kidney Transplant Surgery, Department of Transplant Services, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Rossana Baracco
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan, USA
| | - Gaurav Kapur
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan, USA
| | - Amrish Jain
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan, USA
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2
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Boguszewska A, Wos M, Jarzynski A, Polz-Dacewicz M. Frequency of JC Virus Appearance in the Urine of Post-Transplantation Patients. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2018. [DOI: 10.1515/cipms-2018-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Polyomaviruses are common viruses that induce various infections in many mammalian species, including humans. The best-known viruses of this kind are BKV and JCV. The aim of the study was to analyze the incidence of infection caused by JCV in a group of patients after kidney or bone marrow transplant, and to analyze JCV genetic diversity in post-transplantation recipients. The study group included 81 patients after kidney transplantation treated in the Independent Public Teaching Hospital No 4 in Lublin and a group of 24 patients after marrow transplantation from the Children's Clinical Hospital of Lublin. The research material included 105 DNA probes from urine samples that were tested via the PCR method for the presence of JCV genetic material. Amplification products were separated in agarose gel, positive PCR products were subjected to purification and the pure product was sent to sequencing. Pearson's chi-square test was used to investigate the relationship between the prevalence of JCV viruria and study group and gender. Statistical significance was defined as p < 0.05. A JCV positive result was discovered in 27.6% of all samples. In the group of adults, 34.6% were positive, while in children, this was 3.4%. Among all patients, only 8 women were infected with the JC virus, while 21 men were. We saw that the incidence of infection caused by the JC virus increases with age. Moreover, JCV DNA is more frequently isolated from men than from women. JCV infections are also a more common cause of infections in patients after renal transplantation than in bone marrow transplant patients
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Affiliation(s)
| | - Magdalena Wos
- Department of Virology, Medical University of Lublin, ul. Chodzki, Lublin , Poland
| | - Adrian Jarzynski
- Department of Virology, Medical University of Lublin, ul. Chodzki, Lublin , Poland
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Janphram C, Worawichawong S, Disthabanchong S, Sumethkul V, Rotjanapan P. Absence of JC polyomavirus (JCPyV) viremia in early post-transplant JCPyV nephropathy: A case report. Transpl Infect Dis 2017; 19. [PMID: 28805990 DOI: 10.1111/tid.12761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 02/05/2023]
Abstract
JC polyomavirus (JCPyV)-associated nephropathy (JCPyVAN) occurs in <3% of PVAN cases after renal transplantation. We report the first confirmed case to our knowledge of JCPyVAN diagnosed by kidney biopsy in the early 6 months post transplant in Thailand. In this case report, recovery of renal allograft function was not observed after reduction of immunosuppressive agents and administration of intravenous immunoglobulin and cidofovir. Despite persistent JCPyV viruria, no significant further decline in allograft function was documented at 15 months post transplant.
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Affiliation(s)
- Chitimaporn Janphram
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Division of Renal-Pathology, Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sinee Disthabanchong
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasant Sumethkul
- Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Porpon Rotjanapan
- Division of Infectious Diseases, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Gouvêa ALF, Cosendey RIJ, Carvalho FR, Varella RB, de Souza CF, Lopes PF, Silva AA, Rochael MC, de Moraes HP, Lugon JR, Almeida JR. Pilot Study of Early Monitoring Using Urinary Screening for BK Polyomavirus as a Strategy for Prevention of BKV Nephropathy in Kidney Transplantation. Transplant Proc 2017; 48:2310-2314. [PMID: 27742286 DOI: 10.1016/j.transproceed.2016.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urine monitoring programs represent an important strategy for early diagnosis of reactivation of BK polyomavirus (BKV) in kidney transplant recipients. This study analyzes a BKV urine screening model in kidney transplant patients. METHODS Urinary screening for BKV reactivation was performed by urinary decoy cell and polymerase chain reaction (PCR) tests in samples from 32 consecutive kidney transplant patients, collected in a 6-month follow-up period. PCR in plasma samples and BKV immunohistochemical studies to assess BKV renal disease, if a kidney biopsy was indicated, were performed. RESULTS The urinary screening for BKV among 32 renal receptors was positive in 18 patients (56%) by the concomitant use of the decoy cells and/or qualitative PCR at some time during the study period. Transfusion before transplantation was significantly associated with urinary decoy cell positive screening (odds ratio = 11; 95% confidence interval = 1.47 to 82.4; P < .05); and so was male sex (odds ratio = 2.02; 95% confidence interval = 1.07 to 3.83; P < .05). The clinical management of screening positive cases consisted of decreasing or changing the immunosuppression regimen. Sixteen renal biopsies were performed. Immunohistochemistry for SV40 T antigen was negative in all biopsies. After 1 year of follow-up, no patient developed BKV-associated nephropathy, and there was no difference in renal function between patients positive and negative for BKV urinary screening. CONCLUSIONS Early urinary monitoring is effective in detection of BKV replication and represents a good strategy to minimize the deleterious effects caused by the presence of the virus on preservation of graft function.
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Affiliation(s)
- A L F Gouvêa
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - R I J Cosendey
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - F R Carvalho
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - R B Varella
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - C F de Souza
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - P F Lopes
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - A A Silva
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - M C Rochael
- Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - H P de Moraes
- Faculdade de Ciências Médicas/Anatomia Patológica/Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - J R Lugon
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - J R Almeida
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
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Radtke J, Dietze N, Fischer L, Achilles EG, Li J, Scheidat S, Thaiss F, Nashan B, Koch M. Incidence of BK polyomavirus infection after kidney transplantation is independent of type of immunosuppressive therapy. Transpl Infect Dis 2016; 18:850-855. [PMID: 27639176 DOI: 10.1111/tid.12611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/06/2016] [Accepted: 07/04/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND BK polyomavirus (BKV) infection and BKV nephropathy (BKVN) are risk factors for allograft function and survival. METHODS We retrospectively analyzed BK viremia and BKVN in 348 patients who received a kidney transplantation donated after brain death (n=232) or living donation (n=116) between 2008 and 2013. A total of 266 patients were treated with standard immunosuppression consisting of basiliximab induction, calcineurin inhibitor (CNI), and mycophenolic acid (MPA, n=219) or everolimus (n=47); 82 patients received more intense immunosuppression with lymphocyte depletion, CNI and MPA (n=38) or everolimus (n=44). RESULTS BK viremia occurred in 33 (9.5%) patients in the first year and in 7 (2.0%) recipients in the second year after transplantation. BKVN occurred in 4 (1.1%) patients in the first year. Donor and recipient age, diabetes, previous transplantation, and type of transplantation (donated after brain death vs living donation) were not risk factors (P>.05). BK incidence did not differ depending on induction or maintenance immunosuppression. CONCLUSION Incidence of BK viremia is independent of recipient characteristics, type of transplantation as well as induction and maintenance immunosuppression.
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Affiliation(s)
- Josephine Radtke
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
| | - Nina Dietze
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
| | - Eike-Gert Achilles
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
| | - Jun Li
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
| | - Silke Scheidat
- Department of Internal Medicine III, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
| | - Friedrich Thaiss
- Department of Internal Medicine III, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
| | - Bjoern Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
| | - Martina Koch
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
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BK and JC virus infections in healthy patients compared to kidney transplant recipients in Tunisia. Microb Pathog 2016; 97:204-8. [PMID: 27317859 DOI: 10.1016/j.micpath.2016.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/10/2016] [Accepted: 06/14/2016] [Indexed: 12/14/2022]
Abstract
The human polyomaviruses BKPyV and JCPyV are members of Polyomaviridae family and after primary infections they persist as latent infection especially in the kidneys. BKVPy reactivation is mainly related to a renal nephropathy and JCV reactivation can induce the progressive multifocal leukoencephalopathy. The aim of this study was to investigate and to compare the presence of BKPyV and JCPyV in urine and plasma samples from immunocompromised and immunocompetent groups. The viral detection and quantification was done by a real time PCR from 100 healthy individuals and from 72 kidney transplanted patients (KTx) enrolled in a prospective study. Polyomavirus DNA urinary shedding was identified in 19% of healthy person, BKPyV in 6%; JCPyV more frequent in 13%. No individuals in this group developed polyomavirus viremia. BKPyV and JCPyV viruria was seen in 36% and 28% of KTx respectively, and 11% had a concomitant BKPyV and JCPyV viruria. Only BKPy viremia was detected in 5.5% of the KTx. In healthy persons, JCPyV shedding was associated with older individuals. However, in KTx, BKPyV was associated with younger age and male gender. No significant association was found between the patient's origin and BKPyV or JCPyV infection. In conclusion and consisting with previous reports, BKPyV and JCPyV prevalence and urinary loads were significantly higher in immunosuppressed compared to non-immunosuppressed individuals. In Addition and by contrast to KTx, JCPyV was more frequent than BKPyV in healthy individuals. Furthermore, the shedding of both polyomaviruses was differently associated with the age and the sex according to each population.
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