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Ersal T, Özkalemkaş F, Özkocaman V, Sezen M, Yalçın C, Orhan B, Candar Ö, Çubukçu S, Koca TG. Two Cases of Kidney Transplant Recipients With Multiple Relapsing Pure Red Cell Aplasia Due to Parvovirus B19 Infection. EXP CLIN TRANSPLANT 2024; 22:75-79. [PMID: 36259607 DOI: 10.6002/ect.2022.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Although anemia is common after kidney transplant, pure erythroid aplasia due to parvovirus B19 infection is rare. Therefore, there are delays in diagnosis in transplant patients. Here, we aimed to raise awareness that pure red blood cell aplasia due to parvovirus B19 should be considered in the differential diagnosis of posttransplant anemia. Our report analyzes 2 kidney transplant recipients under immunosuppressive therapy who were diagnosed with pure red blood cell aplasia due to parvovirus B19 infection. Both patients were examined for anemia as a cause for transfusion dependence. Normochromic, normocytic anemia, and reticulocyte levels were low. Leukocyte and platelet counts and biochemical parameters were within reference ranges.Therefore, pure red blood cell aplasia associated with parvovirus B19 was included in the differential diagnosis. Bone marrow showed erythroid hypoplasia and megaloblastic changes with giant erythroblasts containing dark-stained inclusion structures. Results from the other series (neutrophils, lymphocytes, platelets) were within reference ranges. Parvovirus B19 immunoglobulin M and G levels were negative inbothpatients, yet serum parvovirus B19 DNA polymerase chain reaction test results were positive. Therefore, diagnosis was parvovirus B19-associated pure red blood cell aplasia. Anemia resolved completely by 4 weeks after reduction of immunosuppression and intravenous immunoglobulin. Both patients relapsed in month 5 of treatment. One patient relapsed 3 times during follow-up, with complete response to intravenous immunoglobulin for all 3 events.The second patient showed partial response to intravenous immunoglobulin after relapse. We suggest that pure red blood cell aplasia associated with parvovirus B19 should be considered in transplant patients who present with anemia and reticulocytopenia. Negative serology does not exclude thediagnosis, anditis important to perform a parvovirus B19 DNA polymerase chain reaction test. Intravenous immunoglobulin therapy is effective to cure anemia within weeks. Follow-up of patients is important because relapse may occur after treatment.
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Affiliation(s)
- Tuba Ersal
- From the Division of Hematology, Department of Internal Medicine, Bursa Uludag University, Bursa, Turkey
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2
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Imanifard Z, Liguori L, Remuzzi G. TMA in Kidney Transplantation. Transplantation 2023; 107:2329-2340. [PMID: 36944606 DOI: 10.1097/tp.0000000000004585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Thrombotic microangiopathy (TMA) is a rare and devastating complication of kidney transplantation, which often leads to graft failure. Posttransplant TMA (PT-TMA) may occur either de novo or as a recurrence of the disease. De novo TMA can be triggered by immunosuppressant drugs, antibody-mediated rejection, viral infections, and ischemia/reperfusion injury in patients with no evidence of the disease before transplantation. Recurrent TMA may occur in the kidney grafts of patients with a history of atypical hemolytic uremic syndrome (aHUS) in the native kidneys. Studies have shown that some patients with aHUS carry genetic abnormalities that affect genes that code for complement regulators (CFH, MCP, CFI) and components (C3 and CFB), whereas in 10% of patients (mostly children), anti-FH autoantibodies have been reported. The incidence of aHUS recurrence is determined by the underlying genetic or acquired complement abnormality. Although treatment of the causative agents is usually the first line of treatment for de novo PT-TMA, this approach might be insufficient. Plasma exchange typically resolves hematologic abnormalities but does not improve kidney function. Targeted complement inhibition is an effective treatment for recurrent TMA and may be effective in de novo PT-TMA as well, but it is necessary to establish which patients can benefit from different therapeutic options and when and how these can be applied.
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Affiliation(s)
- Zahra Imanifard
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo e Cele Daccò, Ranica, Italy
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3
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Ma Y, Man J, Niu J, Yang L. Progress of research on human parvovirus B19 infection after renal transplantation. Transplant Rev (Orlando) 2022; 36:100730. [DOI: 10.1016/j.trre.2022.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/07/2022]
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4
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Krumova S, Andonova I, Stefanova R, Miteva P, Nenkova G, Hübschen JM. Primate Erythroparvovirus 1 Infection in Patients with Hematological Disorders. Pathogens 2022; 11:497. [PMID: 35631017 PMCID: PMC9143349 DOI: 10.3390/pathogens11050497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 12/10/2022] Open
Abstract
Primate erythroparvovirus 1, commonly referred to as Parvovirus B19 (B19V), is a DNA virus that normally results in a mild childhood infection called "erythema infectiosum". Besides respiratory spread, B19V can also be transmitted through transfusions, which may result in persistent anemia in immunodeficient hosts. Dialysis patients often face acute or chronic anemia after infection with B19V. Here, we describe the laboratory investigation of 21 patients with hematological disorders for B19V infections. B19V DNA was detected in 13 (62%) of them, with specific IgM antibodies in three of the DNA positives. All 13 patients received treatment and were laboratory-monitored over a period of one year. In only two patients (a 14-year-old child with a kidney transplantation and a 39-year-old patient with aplastic anemia), markers of recent B19V infection were still detectable in follow-up samples. For four B19V DNA positive samples, short sequences could be obtained, which clustered with genotype 1a reference strains. Our findings suggest that all cases of hematological disorders should be examined for specific B19V antibodies and DNA for accurate diagnosis and appropriate patient management.
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Affiliation(s)
- Stefka Krumova
- National Reference Laboratory “Measles, Mumps, Rubella”, Department of Virology, National Center of Infectious and Parasitic Diseases, 1233 Sofia, Bulgaria; (I.A.); (R.S.)
| | - Ivona Andonova
- National Reference Laboratory “Measles, Mumps, Rubella”, Department of Virology, National Center of Infectious and Parasitic Diseases, 1233 Sofia, Bulgaria; (I.A.); (R.S.)
| | - Radostina Stefanova
- National Reference Laboratory “Measles, Mumps, Rubella”, Department of Virology, National Center of Infectious and Parasitic Diseases, 1233 Sofia, Bulgaria; (I.A.); (R.S.)
| | - Polina Miteva
- Specialized Hospital for Active Treatment of Children’s Diseases “Prof. Dr. Ivan Mitev” EAD, 1612 Sofia, Bulgaria;
| | - Galina Nenkova
- Department of Biology, Medical University, 9002 Varna, Bulgaria;
| | - Judith M. Hübschen
- Clinical and Applied Virology Group, Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg;
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5
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Yu Y, Wei C, Lyu J, Wu X, Wang R, Huang H, Wu J, Chen J, Peng W. Donor-Derived Human Parvovirus B19 Infection in Kidney Transplantation. Front Cell Infect Microbiol 2021; 11:753970. [PMID: 34722340 PMCID: PMC8554309 DOI: 10.3389/fcimb.2021.753970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background Donor-derived human parvovirus B19 (B19V) infections are rarely reported. Thus, its incidence in kidney transplantation is still unknown due to lack of surveillance studies. Similarly, whether the donor needs to be routinely screened for B19V and whether the kidneys from those with B19V DNAemia could be accepted also remain unknown. Methods This retrospective study aims to evaluate the donor-derived B19V infections occurring in 823 living and 1,225 deceased donor kidney transplantations from January 2016 to December 2020. The serum viral load of living donors and their corresponding recipients was evaluated before and after transplantation. Meanwhile, for the deceased donor kidney transplantation, the serum viral load of recipients was only tested after transplantation; if recipients of a deceased donor subsequently developed B19V infection, the serum viral load of recipients and their corresponding donors before transplantation would then be further traced. Results A total of 15 living donors were B19V DNAemia positive before the donation, of which B19V DNAemia occurred in three corresponding recipients. In deceased donor kidney transplantation, DNAemia occurred simultaneously in 18 recipients and their corresponding nine donors. A progressive decline in hemoglobin and reticulocyte count could be observed in one living donor recipient and other 11 deceased donor recipients, which were all well controlled by treatment eventually. Conclusion The incidence of donor-derived B19V infection was 0.4% and 1.5% in living and deceased kidney transplantations, respectively. B19V was seemingly unnecessary to be routinely screened for the donor. Moreover, kidneys of the donors with B19V infection were acceptable.
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Affiliation(s)
- Yedong Yu
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Chunchun Wei
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Junhao Lyu
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Xiaoliang Wu
- Department of Intensive Care Medicine, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Rending Wang
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Hongfeng Huang
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Jianyong Wu
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Wenhan Peng
- Kidney Disease Center, the First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China.,Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
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6
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Večerić-Haler Ž, Kojc N, Sever M, Zver S, Švajger U, Poženel P, Hartman K, Urdih T, Mlinšek G, Oblak M, Aleš Rigler A, Ihan A, Buturović Ponikvar J, Halloran PP, Arnol M. Case Report: Capillary Leak Syndrome With Kidney Transplant Failure Following Autologous Mesenchymal Stem Cell Therapy. Front Med (Lausanne) 2021; 8:708744. [PMID: 34368198 PMCID: PMC8334176 DOI: 10.3389/fmed.2021.708744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/24/2021] [Indexed: 12/12/2022] Open
Abstract
Mesenchymal stem cells (MSCs) have attracted great interest in the field of kidney transplantation due to their immunomodulatory and reparative properties. In registered clinical trials, MSCs have been used before, at the time of, or early after transplantation and have been reported to be well-tolerated with no serious safety concerns. No results are available on the use of MSCs in the late post-transplant period. Here, we present a case report of a severe systemic complication mimicking capillary leak syndrome with ultimate kidney transplant failure after autologous transplantation of MSCs used as rescue treatment of late antibody-mediated kidney allograft rejection.
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Affiliation(s)
- Željka Večerić-Haler
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nika Kojc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matjaž Sever
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Samo Zver
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Urban Švajger
- Division for Cells and Tissue, Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - Primož Poženel
- Division for Cells and Tissue, Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - Katrina Hartman
- Division for Cells and Tissue, Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - Tereza Urdih
- Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gregor Mlinšek
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Manca Oblak
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andreja Aleš Rigler
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alojz Ihan
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jadranka Buturović Ponikvar
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Philip P Halloran
- Division of Nephrology and Transplant Immunology, University of Alberta, Alberta Transplant Applied Genomics Centre, Edmonton, AB, Canada
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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7
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Ávila A, Gavela E, Sancho A. Thrombotic Microangiopathy After Kidney Transplantation: An Underdiagnosed and Potentially Reversible Entity. Front Med (Lausanne) 2021; 8:642864. [PMID: 33898482 PMCID: PMC8063690 DOI: 10.3389/fmed.2021.642864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/22/2021] [Indexed: 01/25/2023] Open
Abstract
Thrombotic microangiopathy is a rare but serious complication that affects kidney transplant recipients. It appears in 0.8–14% of transplanted patients and negatively affects graft and patient survival. It can appear in a systemic form, with hemolytic microangiopathic anemia, thrombocytopenia, and renal failure, or in a localized form, with progressive renal failure, proteinuria, or arterial hypertension. Post-transplant thrombotic microangiopathy is classified as recurrent atypical hemolytic uremic syndrome or de novo thrombotic microangiopathy. De novo thrombotic microangiopathy accounts for the majority of cases. Distinguishing between the 2 conditions can be difficult, given there is an overlap between them. Complement overactivation is the cornerstone of all post-transplant thrombotic microangiopathies, and has been demonstrated in the context of organ procurement, ischemia-reperfusion phenomena, immunosuppressive drugs, antibody-mediated rejection, viral infections, and post-transplant relapse of antiphospholipid antibody syndrome. Although treatment of the causative agents is usually the first line of treatment, this approach might not be sufficient. Plasma exchange typically resolves hematologic abnormalities but does not improve renal function. Complement blockade with eculizumab has been shown to be an effective therapy in post-transplant thrombotic microangiopathy, but it is necessary to define which patients can benefit from this therapy and when and how eculizumab should be used.
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Affiliation(s)
- Ana Ávila
- Nephrology Department, University Hospital Dr. Peset, Valencia, Spain
| | - Eva Gavela
- Nephrology Department, University Hospital Dr. Peset, Valencia, Spain
| | - Asunción Sancho
- Nephrology Department, University Hospital Dr. Peset, Valencia, Spain
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8
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Kissling S, Rotman S, Gerber C, Halfon M, Lamoth F, Comte D, Lhopitallier L, Sadallah S, Fakhouri F. Collapsing glomerulopathy in a COVID-19 patient. Kidney Int 2020; 98:228-231. [PMID: 32471639 PMCID: PMC7156952 DOI: 10.1016/j.kint.2020.04.006] [Citation(s) in RCA: 253] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Sébastien Kissling
- Service of Nephrology and Hypertension, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Christel Gerber
- Service of Internal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Matthieu Halfon
- Service of Nephrology and Hypertension, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Frédéric Lamoth
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland; Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Denis Comte
- Service of Immunology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Loïc Lhopitallier
- Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Salima Sadallah
- Service of Immunology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Fadi Fakhouri
- Service of Nephrology and Hypertension, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
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9
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Rao A, Konnur A, Gang S, Hegde U, Soni S, Jojera A. Surveillance of viral infections in renal transplant recipients – A prospective observational study. INDIAN JOURNAL OF TRANSPLANTATION 2020. [DOI: 10.4103/ijot.ijot_73_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Vanikar AV, Kanodia KV, Suthar KS, Nigam LA, Patel RD, Thakkar UG, Mehta AH. Thrombotic microangiopathy in a renal allograft: Single-center five-year experience. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:1331-1343. [PMID: 33565445 DOI: 10.4103/1319-2442.308342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Thrombotic microangiopathy (TMA) is devastating for renal transplantation (RT) causing graft/ patient loss. We present 5-year experience of TMA in RT in retrospective study of indicated renal allograft biopsies with TMA. Patient-donor demographics and associated histological findings with respect to transplants under tolerance induction protocol (Group 1) were compared with patients transplanted under triple immunosuppression (Group 2). Statistical analysis was performed using IBM SPSS Statistics version 20. Sixty-one (4.1%) of 1520 biopsies [Group 1:17 (1.9%)/882, Group 2:44 (6.9%)/638] revealed TMA. Tacrolimus trough levels were normal. There was no evidence of systemic involvement in any patient. Mean age was 36.8 years with 70.6% males, HLA-match, 2.6/6, and the most common original disease unknown (41.2%) in Group 1, and 35.9 years with 86.4% males, HLA-match, 2.1/6, and the most common original disease unknown (50%) in Group 2. Biopsies were performed at mean 5.1-year posttransplant in Group 1 and 2.3 years in Group 2. Acute TMA constituted 47% Group 1 and 43.2% Group 2 biopsies; of these, antibody-mediated rejections were observed in 58.8%, T-cell mediated rejections in 11.8%, tacrolimus toxicity in 76.5%, and other findings in 35.3% Group 1; and 61.4%, 25%, 50%, and 18.2%, respectively, in Group 2 biopsies. Higher rejection activity scores were more in Group 2. Postbiopsy 1- and 5- year patient survival was 94.1%, 86.9% in Group 1 and 92.1%, 88.3% in Group 2; 1- and 4-year graft survival was 52.9%, 15.9% in Group 1 and 20.3%, 5.4% in Group 2. TMA was poor prognosticator for RT, especially under triple immunosuppression. Antibody- mediated rejection and tacrolimus toxicity were more prone to TMA.
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Affiliation(s)
- Aruna V Vanikar
- Department of Pathology, Lab Medicine, Transfusion Services and Immunohematology; Department of Stem Cell Therapy and Regenerative Medicine, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital-Medicity Campus, Asarwa, Ahmedabad, India
| | - Kamal V Kanodia
- Department of Pathology, Lab Medicine, Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital-Medicity Campus, Asarwa, Ahmedabad, India
| | - Kamlesh S Suthar
- Department of Pathology, Lab Medicine, Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital-Medicity Campus, Asarwa, Ahmedabad, India
| | - Lovelesh A Nigam
- Department of Pathology, Lab Medicine, Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital-Medicity Campus, Asarwa, Ahmedabad, India
| | - Rashmi D Patel
- Department of Pathology, Lab Medicine, Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital-Medicity Campus, Asarwa, Ahmedabad, India
| | - Umang G Thakkar
- Department of Stem Cell Therapy and Regenerative Medicine, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital-Medicity Campus, Asarwa, Ahmedabad, India
| | - Aanal H Mehta
- Department of Biostatistics, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital-Medicity Campus, Asarwa, Ahmedabad, India
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11
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Gatz JD, Spangler R. Evaluation of the Renal Transplant Recipient in the Emergency Department. Emerg Med Clin North Am 2019; 37:679-705. [PMID: 31563202 DOI: 10.1016/j.emc.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal transplants are becoming more and more frequent in the United States and worldwide. Studies demonstrate that these patients inevitably end up visiting an emergency department. In addition to typical medical and surgical problems encountered in the general population, this group of patients has unique problems arising from their immunocompromised state and also due to side effects of the medications required. This article discusses these risks and management decisions that the emergency department physician should be aware of in order to prevent adverse outcomes for the patient and transplanted kidney.
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Affiliation(s)
- John David Gatz
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA
| | - Ryan Spangler
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA.
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12
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Parvovirus B19-Associated Anemia in Kidney Transplant Recipients: A Single-Center Experience. Transplant Proc 2019; 51:2693-2696. [PMID: 31351772 DOI: 10.1016/j.transproceed.2019.03.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/12/2019] [Indexed: 11/27/2022]
Abstract
Parvovirus B19 (PVB19) has tropism to red blood cell progenitors and can be reactivated after organ transplantation. The aim of study was to describe clinical manifestations, laboratory findings, treatments used, and effectiveness in kidney recipients at Viet Duc hospital. A retrospective descriptive study was performed on 663 kidney recipients who were on regular follow-up from 2000 to 2018. PVB19 was detected by polymerase chain reaction PVB19-DNA. Effectiveness of therapy was assessed by Hemoglobin level. Nine out of 663 kidney recipients (1.4%) were diagnosed with PVB19-associated anemia. Eight of these 9 (89%) were diagnosed within the first 3 months following transplantation. All patients had normoscopic anemia; the average reticulocyte proportion and count were 0.15 ± 0.04% and 0.0039 ± 0.0011T/L, respectively. Graft dysfunction was observed in 4/9 (45%) patients. Treatment included reduction of immunosuppression, intravenous immunoglobulin (IVIG), and blood transfusion. All patients responded well to treatment except 1 (11%), who experienced relapse after using low dose of IVIG. PVB19-associated anemia usually occurred early after transplantation and was associated with very low reticulocyte proportion and count. Actual treatment was effective, but the risk of relapse was present.
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13
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Styles CE, Hoad VC, Gorman E, Roulis E, Flower R, Faddy HM. Modeling the parvovirus B19 blood safety risk in Australia. Transfusion 2018; 59:295-302. [PMID: 30589087 DOI: 10.1111/trf.14965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Three probable cases of transfusion-transmitted (TT) parvovirus B19 (B19V) occurred in Australia between 2014 and 2017. This study aimed to determine the B19V DNA prevalence among blood donors, to model the risk to recipients of fresh components, and to assess risk management options. STUDY DESIGN AND METHODS Plasma samples from 4232 donors were tested for B19V DNA by polymerase chain reaction. Reactive samples were confirmed and viral load determined. A transmission-risk model was used to estimate recipient risk, and the risk from community exposure was estimated using seroprevalence data. RESULTS Two samples (0.0473%, 95% confidence interval [CI] 0.0130-0.172) confirmed positive for B19V DNA had a potentially infectious viral load of 105 IU/mL or higher. The estimated risk of a TT-B19V-associated significant complication was low overall at approximately 1 in 300,000 (95% CI, 1 in 82,000 to 1 in 1 million) fresh components transfused, with 3.1 (95% CI, 0.85-11.3) complications modeled per year. Among vulnerable recipient groups, the risk was higher than 1 in 15,000 patients, but the risk from community exposure far exceeded the transfusion risk for all patient and age groups. CONCLUSION In the context of the small contribution of transfusion to the burden of B19V disease, the significant costs that would be incurred by any strategy to reduce the risk, and given the significant uncertainties and likely overestimation of the risk, we conclude TT-B19V is a tolerable risk to blood safety, despite being high for some vulnerable recipient groups.
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Affiliation(s)
- Claire E Styles
- Donor and Product Safety Unit, Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Veronica C Hoad
- Donor and Product Safety Unit, Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Elise Gorman
- Research and Development, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Eileen Roulis
- Research and Development, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Robert Flower
- Research and Development, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
| | - Helen M Faddy
- Research and Development, Australian Red Cross Blood Service, Brisbane, Queensland, Australia
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14
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Abbas F, El Kossi M, Kim JJ, Sharma A, Halawa A. Thrombotic microangiopathy after renal transplantation: Current insights in de novo and recurrent disease. World J Transplant 2018; 8:122-141. [PMID: 30211021 PMCID: PMC6134269 DOI: 10.5500/wjt.v8.i5.122] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/26/2018] [Accepted: 07/10/2018] [Indexed: 02/05/2023] Open
Abstract
Thrombotic microangiopathy (TMA) is one of the most devastating sequalae of kidney transplantation. A number of published articles have covered either de novo or recurrent TMA in an isolated manner. We have, hereby, in this article endeavored to address both types of TMA in a comparative mode. We appreciate that de novo TMA is more common and its prognosis is poorer than recurrent TMA; the latter has a genetic background, with mutations that impact disease behavior and, consequently, allograft and patient survival. Post-transplant TMA can occur as a recurrence of the disease involving the native kidney or as de novo disease with no evidence of previous involvement before transplant. While atypical hemolytic uremic syndrome is a rare disease that results from complement dysregulation with alternative pathway overactivity, de novo TMA is a heterogenous set of various etiologies and constitutes the vast majority of post-transplant TMA cases. Management of both diseases varies from simple maneuvers, e.g., plasmapheresis, drug withdrawal or dose modification, to lifelong complement blockade, which is rather costly. Careful donor selection and proper recipient preparation, including complete genetic screening, would be a pragmatic approach. Novel therapies, e.g., purified products of the deficient genes, though promising in theory, are not yet of proven value.
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Affiliation(s)
- Fedaey Abbas
- Nephrology Department, Jaber El Ahmed Military Hospital, Safat 13005, Kuwait
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
| | - Mohsen El Kossi
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
- Doncaster Renal Unit, Doncaster Royal Infirmary, Doncaster DN2 5LT, United Kingdom
| | - Jon Jin Kim
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
- Nottingham Children Hospital, Nottingham NG7 2UH, United Kingdom
| | - Ajay Sharma
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
- Transplant Surgery, Royal Liverpool University Hospitals, Liverpool UK L7 8XP, United Kingdom
| | - Ahmed Halawa
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
- Department of Transplantation Surgery, Sheffield Teaching Hospitals, Sheffield S57AU, United Kingdom
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15
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Vadivel K, Ramamurthy M, Sankar S, Jain A, Srikanth P, Ghosh AR, Nandagopal B, Nair A, Sridharan G. Development & standardization of an in-house IgM indirect ELISA for the detection of parvovirus B19 infections. Indian J Med Res 2018; 146:381-385. [PMID: 29355146 PMCID: PMC5793474 DOI: 10.4103/ijmr.ijmr_225_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background & objectives: Parvovirus B19 infections occur worldwide; the infection is acquired early in childhood but could occur later. B19 is reported to cause infection in childhood febrile illnesses, and arthropathies in adults and children and in end-stage renal disease (ESRD) seen in adults. This study was designed to develop an in-house IgM indirect ELISA for serological screening among patients and controls, and to compare ELISA results with those of nested polymerase chain reaction (nPCR) assay. Methods: An in-house IgM indirect ELISA was standardized using peptide sequence of VP1/VP2 region of parvovirus B19. A total of 201 children and adult with febrile illnesses, 216 individuals with non-traumatic arthropathies, 201 cases of chronic anaemia associated with ESRD and 100 healthy controls were tested. Serum was separated from the blood and subsequently used for DNA extraction. The nested polymerase chain reaction (nPCR) for the detection of B19V DNA was performed using primers targeting the overlapping region of VP1/VP2 capsid protein genes. Results: A total of 618 samples were tested for parvovirus B19 by an in-house IgM indirect ELISA. Among these samples, six were positive by in-house ELISA. The inter-rater agreement between ELISA and PCR assays was calculated using kappa coefficient analysis. The value of κ was 0.77 and the strength of agreement was ‘good’ (P<0.001). Interpretation & conclusions: The in-house IgM indirect ELISA was found to be simple with high sensitivity and specificity when compared with nPCR and could be used as an alternative to expensive commercial kits in resource-poor settings.
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Affiliation(s)
- Kumaran Vadivel
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital & Research Centre, Vellore, India
| | - Mageshbabu Ramamurthy
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital & Research Centre, Vellore, India
| | - Sathish Sankar
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital & Research Centre, Vellore, India
| | - Amita Jain
- Department of Microbiology, King George Medical University, Lucknow, India
| | - Padma Srikanth
- Department of Microbiology, Sri Ramachandra Medical College & Research Institute (Deemed to be University), Chennai, India
| | - Asit Ranjan Ghosh
- Centre for Infectious Diseases & Control, School of Biosciences & Technology, VIT University, Vellore, India
| | - Balaji Nandagopal
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital & Research Centre, Vellore, India
| | - Aravindan Nair
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital & Research Centre, Vellore, India
| | - Gopalan Sridharan
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital & Research Centre, Vellore, India
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16
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Garg N, Rennke HG, Pavlakis M, Zandi-Nejad K. De novo thrombotic microangiopathy after kidney transplantation. Transplant Rev (Orlando) 2017; 32:58-68. [PMID: 29157988 DOI: 10.1016/j.trre.2017.10.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 10/22/2017] [Accepted: 10/23/2017] [Indexed: 12/14/2022]
Abstract
Thrombotic microangiopathy (TMA) is a serious complication of transplantation that adversely affects kidney transplant recipient and allograft survival. Post-transplant TMA is usually classified into two categories: 1) recurrent TMA and 2) de novo TMA. Atypical hemolytic uremic syndrome (aHUS) resulting from dysregulation and over-activation of the alternate complement pathway is a rare disease but the most common diagnosis associated with recurrence in the allografts. De novo TMA, on the other hand, represents an overwhelming majority of the cases of post-transplant TMA and is a substantially more heterogeneous entity than recurrent aHUS. Here, we review the etio-pathogenesis, diagnosis and treatment options for de novo post-transplant TMA. It is usually in the setting of calcineurin inhibitor use, mammalian target of rapamycin inhibitor use, or antibody mediated rejection; recently genetic mutations in complement regulatory genes for Factor H and Factor I similar to those described in aHUS have been reported in up to a third of these patients. Systemic signs of TMA are frequently absent, and a renal allograft biopsy is often needed to establish the diagnosis. Although withdrawal of the offending agents is usually the first line of treatment and resolution of laboratory abnormalities has been documented with this approach in several case reports and case series, available retrospective data demonstrate lack of benefit in long-term graft outcomes. Co-stimulation blockage with belatacept provides an effective alternate immunosuppressive strategy for these patients. Anti-complement therapy with eculizumab is effective in some cases; further work is required to define which patients with TMA (with and without concomitant antibody-mediated rejection) would benefit from receiving this treatment, and what biomarkers can be used to identify them.
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Affiliation(s)
- Neetika Garg
- Department of Medicine, Nephrology Division, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States.
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, United States
| | - Martha Pavlakis
- Department of Medicine, Nephrology Division, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States
| | - Kambiz Zandi-Nejad
- Department of Medicine, Nephrology Division, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States
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17
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Würdinger M, Modrow S, Plentz A. Impact of Parvovirus B19 Viremia in Liver Transplanted Children on Anemia: A Retrospective Study. Viruses 2017; 9:v9060149. [PMID: 28608818 PMCID: PMC5490825 DOI: 10.3390/v9060149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/30/2017] [Accepted: 06/06/2017] [Indexed: 12/18/2022] Open
Abstract
Acute parvovirus B19 (B19V) infection in immunocompromised patients may lead to severe anemia. However, in adult transplant recipients, B19V reactivations without anemia and low-level viremia are common. The impact of B19V in pediatric transplant patients, with high risk of primary infection, is investigated here. In a six-month period, 159 blood samples of 54 pediatric liver transplant recipients were tested for B19V DNA by quantitative real-time PCR. Viremia was correlated with anemia and immunosuppression and compared with rates in adult transplant recipients. B19V DNA was detected in 5/54 patients. Primary B19V infections were observed in four patients prior to and in one patient after transplantation. Rates of viremia were significantly higher in pediatric recipients than in adults. Prolonged virus shedding after primary infection prior to transplantation accounts for most viremic cases. Anemia was significantly more frequent in samples from viremic patients, but remained mild. In 15% of anemic samples, B19V DNA was detected. Therefore, in anemic pediatric transplant recipients, diagnostics for B19V seem reasonable.
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Affiliation(s)
- Michael Würdinger
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
- Department of Surgery and Transplantation, University Hospital of Zurich, 8091 Zürich, Switzerland.
| | - Susanne Modrow
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
| | - Annelie Plentz
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
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18
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Malbora B, Saritas S, Ataseven E, Belen B, Alparslan C, Yavascan O, Yilmaz Ciftdogan D, Atabay B, Turker M. Pure Red Cell Aplasia Due to Parvovirus B19: Erythropoietin-Resistant Anemia in a Pediatric Kidney Recipient. EXP CLIN TRANSPLANT 2017; 15:369-371. [PMID: 28387173 DOI: 10.6002/ect.2016.0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Baris Malbora
- From the Department of Pediatric Hematology and Oncology, Tepecik Education and Training Hospital, Izmir, Turkey
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19
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Abstract
Parvovirus B19 (B19V) and human bocavirus 1 (HBoV1), members of the large Parvoviridae family, are human pathogens responsible for a variety of diseases. For B19V in particular, host features determine disease manifestations. These viruses are prevalent worldwide and are culturable in vitro, and serological and molecular assays are available but require careful interpretation of results. Additional human parvoviruses, including HBoV2 to -4, human parvovirus 4 (PARV4), and human bufavirus (BuV) are also reviewed. The full spectrum of parvovirus disease in humans has yet to be established. Candidate recombinant B19V vaccines have been developed but may not be commercially feasible. We review relevant features of the molecular and cellular biology of these viruses, and the human immune response that they elicit, which have allowed a deep understanding of pathophysiology.
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Affiliation(s)
- Jianming Qiu
- Department of Microbiology, Molecular Genetics and Immunology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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20
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Markova AA, Arelin V, Jäckel E, Richter N, Lehner F, Wagner AD, Schiffer M. Aseptic arthritis due to parvovirus B19 infection immediately after kidney and pancreas transplantation. TRANSPLANTATION REPORTS 2016. [DOI: 10.1016/j.tpr.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Parodis López Y, Santana Estupiñán R, Marrero Robayna S, Gallego Samper R, Henríquez Palop F, Rivero Vera JC, Camacho Galán R, Pena López MJ, Sablón González N, González Cabrera F, Oliva Dámaso E, Vega Díaz N, Rodríguez Pérez JC. Anaemia and fever in Kidney transplant. The role of human parvovirus B19. Nefrologia 2016; 37:206-212. [PMID: 27865549 DOI: 10.1016/j.nefro.2016.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 05/27/2016] [Accepted: 08/25/2016] [Indexed: 11/17/2022] Open
Abstract
Infections remain an issue of particular relevance in renal transplant patients, particularly viral infections. Human parvovirus B19 infection causes severe refractory anaemia, pancytopenia and thrombotic microangiopathy. Its presence is recognized by analysing blood polymerase chain reaction (PCR) and by the discovery of typical giant proerythroblasts in the bone marrow. We report the case of a 65 year-old man with a history of deceased donor renal transplant in September 2014. At 38 days after the transplant, the patient presented progressive anaemia that was resistant to erythropoiesis-stimulating agents. At 64 days after transplant, hyperthermia occurred with progressive deterioration of the patient's general condition. The viral serology and the first blood PCR for human parvovirus B19 were both negative. At 4 months and 19 days after, a bone marrow biopsy was conducted, showing giant erythroblasts with nuclear viral inclusions that were compatible with parvovirus; a PCR in the tissue confirmed the diagnosis. A second blood PCR was positive for parvovirus. After treatment with intravenous immunoglobulin and the temporary discontinuation of mycophenolate mofetil, a complete remission of the disease occurred, although the blood PCR for parvovirus B19 remained positive, so monitoring is necessary for future likely recurrence.
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Affiliation(s)
- Yanet Parodis López
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Raquel Santana Estupiñán
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Silvia Marrero Robayna
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Roberto Gallego Samper
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Fernando Henríquez Palop
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - José Carlos Rivero Vera
- Servicio de Anatomía Patológica, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Rafael Camacho Galán
- Servicio de Anatomía Patológica, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - María José Pena López
- Servicio de Microbiología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Nery Sablón González
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Fayna González Cabrera
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Elena Oliva Dámaso
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Nicanor Vega Díaz
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - José Carlos Rodríguez Pérez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
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22
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Dropulic LK, Lederman HM. Overview of Infections in the Immunocompromised Host. Microbiol Spectr 2016; 4:10.1128/microbiolspec.DMIH2-0026-2016. [PMID: 27726779 PMCID: PMC8428766 DOI: 10.1128/microbiolspec.dmih2-0026-2016] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 12/12/2022] Open
Abstract
Understanding the components of the immune system that contribute to host defense against infection is key to recognizing infections that are more likely to occur in an immunocompromised patient. In this review, we discuss the integrated system of physical barriers and of innate and adaptive immunity that contributes to host defense. Specific defects in the components of this system that predispose to particular infections are presented. This is followed by a review of primary immunodeficiency diseases and secondary immunodeficiencies, the latter of which develop because of a specific illness or condition or are treatment-related. The effects of treatment for neoplasia, autoimmune diseases, solid organ and stem cell transplants on host defenses are reviewed and associated with susceptibility to particular infections. In conclusion, an approach to laboratory screening for a suspected immunodeficiency is presented. Knowledge of which host defects predispose to specific infections allows clinicians to prevent, diagnose, and manage infections in their immunocompromised patients most effectively.
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Affiliation(s)
- Lesia K Dropulic
- The National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of Intramural Research, Bethesda, MD 20892
| | - Howard M Lederman
- Departments of Pediatrics, Medicine, and Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287
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23
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Krishnan P, Ramadas P, Rajendran PP, Madhavan P, Alex A, Jayaschandran V, Humayun SG, Ali N, Sachdeva M, Flecha A, Basu A, Bhaskaran M, Molmenti EP. Effects of Parvovirus B19 Infection in Renal Transplant Recipients: A Retrospective Review of Three Cases. Int J Angiol 2015; 24:87-92. [PMID: 26060378 DOI: 10.1055/s-0034-1371759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Parvovirus B19 (PVB19) is a DNA virus which causes clinically relevant infection in renal transplant recipients (RTR) leading to significant morbidity. Manifestations include erythropoietin resistant anemia, proteinuria, and glomerulosclerosis in the allograft. Severe infection may require administration of intravenous immunoglobulin, reduction in immunosuppression and transfusions. The major challenge in managing and preventing the infection in RTR involves the act of balancing the decreased level of immunosuppression and the risk of rejection. The objective of this article is to understand the importance of PVB19 infection and its outcome in RTR. We reviewed the medical records of three RTR with confirmed PVB19 infection and recorded patient information including demographics, clinical and laboratory data, management, and outcome. The average time of occurrence of PVB19 infection as transplant was 8.6 weeks and they presented with symptomatic anemia. Elevated creatinine values were noted in two of them. Following treatment, anemia improved and creatinine values returned to baseline. One of them developed an early relapse and had to be treated once again similarly. We emphasize the importance of maintaining a high index of suspicion for PVB19 infection in patients with anemia in the posttransplant phase, especially in patients on higher doses of immunosuppressants. Early and proper treatment can prevent worsening clinical condition and possible effects on the allograft.
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Affiliation(s)
- Prathik Krishnan
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Poornima Ramadas
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Prejith P Rajendran
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Parvathy Madhavan
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Asha Alex
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Vivek Jayaschandran
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Shaesta G Humayun
- Department of Anesthesiology, Brookdale University Hospital and Medical Center, Boulevard, Manhasset, New York
| | - Nicole Ali
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Mala Sachdeva
- Department of Nephrology, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Antonette Flecha
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Amit Basu
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Madhu Bhaskaran
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
| | - Ernesto P Molmenti
- Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York
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24
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Josephson MA, Perazella MA, Choi MJ. American society of Nephrology Quiz and Questionnaire 2014: transplantation. Clin J Am Soc Nephrol 2015; 10:903-9. [PMID: 25862775 DOI: 10.2215/cjn.12221214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Nephrology Quiz and Questionnaire remains an extremely popular session for attendees of the Annual Kidney Week Meeting of the American Society of Nephrology. Once again, the conference hall was overflowing with audience members and eager quiz participants. Topics covered by the expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories along with single best answer questions were prepared and submitted by the panel of experts. Before the meeting, program directors of United States nephrology training programs and nephrology fellows answered the questions through an internet-based questionnaire. During the live session, members of the audience tested their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They compared their answers in real time using audience response devices with the answers of the nephrology fellows and training program directors. The correct and incorrect answers were then discussed after the audience responses and the results of the questionnaire were displayed. As always, the audience, lecturers, and moderators enjoyed this educational session. This article recapitulates the session and reproduces its educational value for the readers of CJASN. Enjoy the clinical cases and expert discussions.
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Affiliation(s)
| | - Mark A Perazella
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Michael J Choi
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Varshney P, Verma V, Verma N, Gupta AK, Kumar Singhal M. An unusual case of post-renal transplant anemia induced by Parvovirus B19. INDIAN JOURNAL OF TRANSPLANTATION 2014. [DOI: 10.1016/j.ijt.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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26
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Clinical investigation of human parvovirus B19 infection after renal transplantation in China. Transplant Proc 2013; 45:1593-9. [PMID: 23726627 DOI: 10.1016/j.transproceed.2013.02.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 01/24/2013] [Accepted: 02/06/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We investigated the incidence of human parvovirus B19 (HPV B19) infection after renal transplantation as well as the risk of anemia and renal allograft damage among infected transplant recipients in China. METHODS We selected 114 patients at 1-18 months after renal transplantation for detection of HPV B19 DNA copies compared with a control population. Renal function and hematopoiesis were compared between infected and noninfected groups. RESULTS Twenty-seven patients diagnosed with HPV B19 infection during follow-up (18.75%),which was a significantly higher number than among the general population over the same period. Infected versus nonaffected patients exhibited a significantly higher incidence of anemia and urinary abnormalities in addition to significantly lower values of hemoglobin, higher serum creatinine concentrations, and lower glomerular filtration rates. The 2 groups did not differ in the types or doses of calcineurin inhibitor (CNI) immunosuppressants. Two cases of pure red cell aplasia (PRCA) as confirmed using bone marrow biopsy, were observed in the infected group. They displayed HPV B19 DNA copy numbers >10(7)/mL and segmental mesangial cell proliferation on renal biopsy. The PRCA cases were cured with immunomodulatory therapy. CONCLUSIONS The HPV B19 infection rate was significantly higher among renal transplant recipients than normal controls. Infections correlated with damage to the renal allograft, which may in turn cause PRCA. Immunomodulation therapy was effective to treat this complication of HPV B19 infection.
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Alves MT, Vilaça SS, Carvalho MDG, Fernandes AP, Dusse LMSA, Gomes KB. Human parvovirus B19 infection in a renal transplant recipient: a case report. BMC Res Notes 2013; 6:28. [PMID: 23343210 PMCID: PMC3570302 DOI: 10.1186/1756-0500-6-28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/18/2013] [Indexed: 12/02/2022] Open
Abstract
Background Parvovirus B19 presents tropism for human erythroid progenitor cells, causing chronic anemia in organ transplant recipients, due to their suppressed humoral and cellular responses. Diagnosis may be achieved through serological tests for detection of anti-B19 antibodies. However, renal transplant recipients are not routinely tested for parvovirus B19 infection, since there is scanty data or consensus on screening for B19 infection, as well as for treatment or preventive management of transplanted patients. Case presentation Herein we report a kidney transplant recipient, who was unresponsive to treatment of severe anemia, and presented hypocellular hematopoietic marrow, megaloblastosis and hypoplasia of erythroid lineage with larger cells with clear nuclei chromatin and eosinophilic nuclear inclusions. This patient was seropositive for Epstein-Barr and Cytomegalovirus infections and negative for anti-parvovirus B19 IgM and IgG antibodies, although symptoms were suggestive of parvoviruses infection. A qualitative polymerase chain reaction testing for B19 in serum sample revealed positive results for B19 virus DNA. Conclusion This case report suggests that the diagnostic process for parvovirus B19 in renal transplant recipients should include a polymerase chain reaction assay to detect B19-DNA, since specific serological tests may be unreliable given their impaired humoral responses. These results also indicate the importance of considering parvovirus B19 infection in the differential diagnosis of persistent anemia in transplanted patients.
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Affiliation(s)
- Michelle Teodoro Alves
- Departamento de Biologia Geral, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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da Costa A, Bendit I, de Oliveira A, Kallas E, Sabino E, Sanabani S. Investigation of human parvovirus B19 occurrence and genetic variability in different leukaemia entities. Clin Microbiol Infect 2013; 19:E31-E43. [DOI: 10.1111/1469-0691.12058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/01/2012] [Accepted: 09/24/2012] [Indexed: 11/28/2022]
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Stiehm ER, Keller MA. Passive immunization. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Fujita E, Shimizu A, Kaneko T, Masuda Y, Ishihara C, Mii A, Higo S, Kajimoto Y, Kanzaki G, Nagasaka S, Iino Y, Katayama Y, Fukuda Y. Proliferative glomerulonephritis with monoclonal immunoglobulin G3κ deposits in association with parvovirus B19 infection. Hum Pathol 2012; 43:2326-33. [DOI: 10.1016/j.humpath.2012.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/10/2012] [Accepted: 04/11/2012] [Indexed: 11/28/2022]
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Brennan DC, Aguado JM, Potena L, Jardine AG, Legendre C, Säemann MD, Mueller NJ, Merville P, Emery V, Nashan B. Effect of maintenance immunosuppressive drugs on virus pathobiology: evidence and potential mechanisms. Rev Med Virol 2012; 23:97-125. [PMID: 23165654 DOI: 10.1002/rmv.1733] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 09/07/2012] [Accepted: 09/20/2012] [Indexed: 12/11/2022]
Abstract
Recent evidence suggesting a potential anti-CMV effect of mTORis is of great interest to the transplant community. However, the concept of an immunosuppressant with antiviral properties is not new, with many accounts of the antiviral properties of several agents over the years. Despite these reports, to date, there has been little effort to collate the evidence into a fuller picture. This manuscript was developed to gather the evidence of antiviral activity of the agents that comprise a typical immunosuppressive regimen against viruses that commonly reactivate following transplant (HHV1 and 2, VZV, EBV, CMV and HHV6, 7, and 8, HCV, HBV, BKV, HIV, HPV, and parvovirus). Appropriate immunosuppressive regimens posttransplant that avoid acute rejection while reducing risk of viral reactivation are also reviewed. The existing literature was disparate in nature, although indicating a possible stimulatory effect of tacrolimus on BKV, potentiation of viral reactivation by steroids, and a potential advantage of mammalian target of rapamycin (mTOR) inhibition in several viral infections, including BKV, HPV, and several herpesviruses.
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Gosset C, Viglietti D, Hue K, Antoine C, Glotz D, Pillebout E. How many times can parvovirus B19-related anemia recur in solid organ transplant recipients? Transpl Infect Dis 2012; 14:E64-70. [DOI: 10.1111/j.1399-3062.2012.00773.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/07/2012] [Accepted: 03/13/2012] [Indexed: 12/22/2022]
Affiliation(s)
- C. Gosset
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
| | - D. Viglietti
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
| | - K. Hue
- Néphrologie; CHU Pointe-à-Pitre; Guadeloupe; France
| | - C. Antoine
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
| | - D. Glotz
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
| | - E. Pillebout
- Néphrologie-Transplantation; Hôpital Saint-Louis; Université Paris VII; Paris; France
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Randhawa P, Mannon RB. A case of late kidney allograft failure: a clinical pathological conference from American Society of Nephrology Kidney Week 2011. Clin J Am Soc Nephrol 2012; 7:1884-9. [PMID: 22859745 DOI: 10.2215/cjn.04920512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Parmjeet Randhawa
- Department of Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Calistru AM, Lisboa C, Cunha AP, Bettencourt H, Azevedo F. Acute generalized exanthematous pustulosis to amoxicillin associated with parvovirus B19 reactivation. Cutan Ocul Toxicol 2012; 31:258-61. [DOI: 10.3109/15569527.2011.645978] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chow KM, Szeto CC, Chan NPH, Li PKT. Quiz Page December 2010. Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kumar D, Humar A. Respiratory viral infections in transplant and oncology patients. Infect Dis Clin North Am 2010; 24:395-412. [PMID: 20466276 PMCID: PMC7135290 DOI: 10.1016/j.idc.2010.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Deepali Kumar
- Department of Medicine, Transplant Infectious Diseases, University of Alberta, 6-030 Katz-Rexall Center for Health Research, Edmonton, Alberta T6G 2E1, Canada.
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Leen AM, Tripic T, Rooney CM. Challenges of T cell therapies for virus-associated diseases after hematopoietic stem cell transplantation. Expert Opin Biol Ther 2010; 10:337-51. [PMID: 20132056 DOI: 10.1517/14712590903456003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE OF THE FIELD Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for many hematological malignancies and genetic disorders. The majority of patients do not have a human leukocyte antigen (HLA) identical sibling donor, and alternative stem cell sources include HLA-matched or mismatched unrelated donors and haploidentical related donors. However, alternative donor HSCT are associated with three major complications i) graft rejection; ii) graft-versus-host disease (GvHD); and iii) delayed immune reconstitution leading to viral infections and relapse. AREAS COVERED IN THIS REVIEW Graft rejection and the risk of GvHD can be significantly reduced by using intensive conditioning regimens, including in vivo T cell depletion as well as ex vivo T cell depletion of the graft. However, the benefits of removing alloreactive T cells from the graft are offset by the concomitant removal of T cells with anti-viral or anti-tumor activity as well as the profound delay in endogenous T cell recovery post-transplant. Thus, opportunistic infections, many of which are not amenable to conventional small-molecule therapeutics, are frequent in these patients and are associated with significant morbidity and high mortality rates. This review discusses current cell therapies to prevent or treat viral infections/reactivations post-transplant. WHAT THE READER WILL GAIN The reader will gain an understanding of the current state of cell therapy to prevent and treat viral infections post-HSCT, and will be introduced to preclinical studies designed to develop and validate new manufacturing procedures intended to improve therapeutic efficacy and reduce associated toxicities. TAKE HOME MESSAGE Reconstitution of HSCT recipients with antigen-specific T cells, produced either by allodepletion or in vitro reactivation, can offer an effective strategy to provide both immediate and long-term protection without harmful alloreactivity.
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Affiliation(s)
- Ann M Leen
- The Methodist Hospital, Texas Children's Hospital, Center for Cell and Gene Therapy, Baylor College of Medicine, 1102 Bates Street, Houston, TX 77030, USA.
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Dennert R, Velthuis S, Schalla S, Eurlings L, van Suylen RJ, van Paassen P, Tervaert JWC, Wolffs P, Goossens VJ, Bruggeman C, Waltenberger J, Crijns HJ, Heymans S. Intravenous immunoglobulin therapy for patients with idiopathic cardiomyopathy and endomyocardial biopsy-proven high PVB19 viral load. Antivir Ther 2010; 15:193-201. [DOI: 10.3851/imp1516] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- A J Eid
- University of Kansas Medical Center, Kansas City, KS, USA.
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Abstract
The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.
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Kahwaji J, Barker E, Pepkowitz S, Klapper E, Villicana R, Peng A, Chang R, Jordan SC, Vo AA. Acute hemolysis after high-dose intravenous immunoglobulin therapy in highly HLA sensitized patients. Clin J Am Soc Nephrol 2009; 4:1993-7. [PMID: 19833910 DOI: 10.2215/cjn.04540709] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Intravenous Ig (IVIG) is used in renal transplantation for desensitization and treatment of antibody-mediated rejection (AMR). The infusion of high-dose IVIG is generally well tolerated, but there are reports of hemolytic anemia induced by anti-blood group antibodies present in IVIG. Here, we report our experience with IVIG-induced hemolytic anemia (IH) in ESRD patients receiving IVIG for desensitization or treatment of AMR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients receiving IVIG for desensitization or for treatment of AMR were monitored for evidence of acute anemia and hemolysis. Markers of hemolysis, including direct antiglobulin tests, were recorded. Five different IVIG products were tested for isohemagglutinin titers. RESULTS There were 18 cases of IH in 16 patients. All identified cases received the IVIG product Gamunex, Gammagard liquid, or Privigen. All patients developing hemolysis were non-O blood types. Isohemagglutinin titers ranged from 1:2 to 1:64 in the various IVIG products, with higher titers noted in the liquid, nonlyophilized products. CONCLUSIONS Acute IH is a significant complication of high-dose IVIG infusion. Identified risk factors include non-O blood type of the recipient and administration of liquid IVIG preparations with high titer anti-A/B IgG antibodies. We recommend monitoring hemoglobin 48 to 72 h after IVIG infusion. If the hemoglobin decreases, a hemolytic work-up is recommended. Hemolysis could be avoided in at risk patients by choosing a low titer product. However, other complications such as acute renal failure or thrombosis may be seen because the low titer products are usually hyperosmotic.
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Affiliation(s)
- Joseph Kahwaji
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, West Los Angeles, CA 90048, USA.
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Muthusamy A, Vaidya A, Sinha S, Atabani S, Haque T, Jones G, Cunningham J, Friend P. Pancreas allograft thrombosis following intravenous immunoglobulin administration to treat parvovirus B19 infection. Transpl Infect Dis 2009; 11:463-6. [DOI: 10.1111/j.1399-3062.2009.00419.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Montanari M, Cortelezzi C, Parravicini M, Gianfrate L, Piana S, Segato S. Parvovirus B19 infection and immunosuppressed IBD-affected pediatricians. Am J Gastroenterol 2009; 104:537. [PMID: 19174790 DOI: 10.1038/ajg.2008.93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Barzon L, Murer L, Pacenti M, Biasolo M, Vella M, Benetti E, Zanon G, Palù G. Investigation of Intrarenal Viral Infections in Kidney Transplant Recipients Unveils an Association between Parvovirus B19 and Chronic Allograft Injury. J Infect Dis 2009; 199:372-80. [DOI: 10.1086/596053] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ardalan MR, Shoja MM, Tubbs RS, Esmaili H, Keyvani H. Postrenal transplant hemophagocytic lymphohistiocytosis and thrombotic microangiopathy associated with parvovirus b19 infection. Am J Transplant 2008; 8:1340-4. [PMID: 18522549 DOI: 10.1111/j.1600-6143.2008.02244.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Persistent anemia is a known consequence of Parvovirus B19 (B19) infection following renal transplantation. However, to date, no description of B19-related hemophagocytic lymphohistiocytosis (HLH) exists in renal transplant recipients. We report a 24-year-old male kidney recipient, who presented with fever, severe anemia and allograft dysfunction two years following transplantation. Hyperferritinemia, hypertriglyceridemia, elevated serum lactate dehydrogenase, pancytopenia and fragmented red blood cells on the peripheral blood were also noted. Bone marrow examination revealed giant pronormoblasts and frequent histiocytes with intracellular hematopoietic elements, consistent with HLH. Renal allograft biopsy revealed closure of the lumen of glomerular capillaries and thickening of the capillary walls compatible with thrombotic microangiopathy. The presence of anti-B19 IgM antibody and viral DNA in the patient's serum (detected by real-time PCR) confirmed an acute B19 infection. Following high-dose intravenous immunoglobulin therapy, the anemia gradually resolved and renal function improved. As far as we know, this is the first report of B19-associated HLH and thrombotic microangiopathy in a renal transplant recipient.
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Affiliation(s)
- M R Ardalan
- Department of Nephrology, Tabriz University of Medical Sciences, Tabriz, Iran
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