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Sabanci M, Taşdemir M, Öksüz B, Altuner Torun Y, Sütçü M, Özkaya O. Managing recurrent parvovirus B19-associated anemia after a pediatric kidney transplant. Pediatr Nephrol 2024; 39:2923-2925. [PMID: 38775967 PMCID: PMC11349799 DOI: 10.1007/s00467-024-06378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/14/2024] [Accepted: 04/03/2024] [Indexed: 08/28/2024]
Abstract
A 13-year-old girl who had a kidney transplant four weeks prior presented with a 10-day history of fatigue, paleness, and headache. On physical examination, tachycardia and paleness were noted. Laboratory testing was notable for severe anemia and mild leukopenia and thrombocytopenia. Polymerase chain reaction (PCR) test for Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were negative and for parvovirus B19 (PVB19) was positive. Despite lower immunosuppression and administration of intravenous immunoglobulin (IVIG) it persisted for 15 months, and frequent red blood cell transfusions were needed. PVB19 is a less common but significant complication. The patient's clinical course demonstrates the importance of this complication and the challenges in its management. A notable void exists in the literature regarding standardized treatment protocols for PVB19-induced recurrent anemia after kidney transplant. This case indicates the need for further research and consensus to guide effective clinical interventions in similar cases.
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Affiliation(s)
| | - Mehmet Taşdemir
- Division of Pediatric Nephrology, Department of Pediatrics, İstinye University School of Medicine, Azerbaycan Caddesi, No: 4/A, Sarıyer, Istanbul, Türkiye.
| | - Burcu Öksüz
- Molecular Infection Laboratory, Genetic Diseases Diagnosis Center, İstinye University, Istanbul, Turkey
| | - Yasemin Altuner Torun
- Division of Pediatric Hematology, Department of Pediatrics, İstinye University School of Medicine, Istanbul, Turkey
| | - Murat Sütçü
- Division of Pediatric Infectious Disease, Department of Pediatrics, İstinye University School of Medicine, Istanbul, Turkey
| | - Ozan Özkaya
- Division of Pediatric Nephrology, Department of Pediatrics, İstinye University School of Medicine, Azerbaycan Caddesi, No: 4/A, Sarıyer, Istanbul, Türkiye
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2
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Aghaei M, Sarabi MA. A are cause of post-renal transplant anemia by parvovirus-B19: Case report. Transpl Immunol 2024; 87:102118. [PMID: 39241810 DOI: 10.1016/j.trim.2024.102118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/25/2024] [Accepted: 09/01/2024] [Indexed: 09/09/2024]
Abstract
One of the issues during the post-transplant phase is anemia. The increased risk of graft rejection makes evaluating transplant recipients difficult. Parvovirus-B19 (PV-B19) should be considered one of the differential diagnosis of post-transplant anemia (PTA) in renal transplantation recipients. In this article, we report a 32 year old man who was admitted to the hospital with anemia. During the assessment, infection with PV-B19 was confirmed as the cause of the anemia. He received intravenous immunoglobin (IVIG) as the treatment.
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Affiliation(s)
- Mona Aghaei
- School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran.
| | - Mohammad Amir Sarabi
- School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
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3
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Tang Y, Guo J, Zhou J, Wan Z, Li J, Qiu T. Risk factors and current state of therapy for anemia after kidney transplantation. Front Med (Lausanne) 2024; 10:1170100. [PMID: 38264045 PMCID: PMC10804853 DOI: 10.3389/fmed.2023.1170100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
Post-transplant anemia is one of the most common complications in kidney transplant recipients, severely affecting patient prognosis and quality of life, and is an independent predictor of graft kidney loss and patient mortality. However, our clinical understanding and the attention given to post-transplant anemia are currently insufficient. This paper reviews the current status, risk factors, and therapeutic progress in anemia after transplantation in kidney transplant recipients. We recommend that clinical staff pay attention to anemia and its complications in kidney transplant recipients and intervene early for anemia.
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Affiliation(s)
- Yan Tang
- The Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jiayu Guo
- The Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jiangqiao Zhou
- The Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zijie Wan
- The Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jinke Li
- The Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Tao Qiu
- The Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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4
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Hou YB, Chang S, Chen S, Zhang WJ. Intravenous immunoglobulin in kidney transplantation: Mechanisms of action, clinical applications, adverse effects, and hyperimmune globulin. Clin Immunol 2023; 256:109782. [PMID: 37742791 DOI: 10.1016/j.clim.2023.109782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
Intravenous immunoglobulin (IVIG) has been developed for over 40 years. The mechanisms of action of IVIG are complex and diverse, and there may be multiple mechanisms that combine to influence it. IVIG has been used in kidney transplantation for desensitization, treatment of antibody-mediated rejection, and ABO-incompatible transplantation. and treatment or prevention of some infectious diseases. Hyperimmune globulins such as cytomegalovirus hyperimmune globulin (CMV-IG) and hepatitis B hyperimmune globulin (HBIG) have also been used to protect against cytomegalovirus and hepatitis B virus, respectively. However, IVIG is also associated with some rare but serious adverse effects and some application risks, and clinicians need to weigh the pros and cons and develop individualized treatment programs to benefit more patients. This review will provide an overview of the multiple mechanisms of action, clinical applications, adverse effects, and prophylactic measures of IVIG, and hyperimmune globulin will also be introduced in it.
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Affiliation(s)
- Yi-Bo Hou
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China
| | - Sheng Chang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China
| | - Song Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China
| | - Wei-Jie Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China.
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5
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Tambi P, Dave R, Kute V, Patel HV, Shah S, Yadav R. Parvovirus in Kidney Transplant Recipients: A Single-Center Experience. EXP CLIN TRANSPLANT 2023; 21:868-871. [PMID: 38140930 DOI: 10.6002/ect.2023.0127] [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: 12/24/2023]
Abstract
OBJECTIVES Parvovirus testing is not done in routine clinical practice; thus, it is possible that reported parvovirus cases are just the tip of the iceberg of total prevalence. We present a single-center retrospective analysis of 22 events of parvovirus B19 anemia in 20 renal transplant recipients, among which 2 patients had recurrence. MATERIALS AND METHODS For this descriptive analytical study, parvovirus B19 disease was defined as parvovirus infection (detection by real-time polymerase chain reaction) in the presence of anemia with clinical symptoms or bone marrow biopsy findings consistent with the diagnosis. Study duration was 18 months, from June 2021 through December 2022, and patients were enrolled from a single center. RESULTS All patients detected with the virus had received induction with thymocyte globulin and were on standard triple drug immunosuppression. Mean age was 32 ± 12 years with median time to diagnosis of 2 months after transplant. Anemia was observed in all patients with mean hemoglobin level at presentation of 6.02 ± 1.28 g/dL. Creatinine at presentation was 1.49 mg/dL (interquartile range, 0.92-2.69 mg/dL). The most common presentation was asymptomatic patient with evaluation for anemia. During therapy, the highest median creatinine level was 2.0 mg/dL (interquartile range, 1.38-3.2 mg/dL), which was significantly higher than that at presentation (P < .018). After therapy, median creatinine level was 1.3 mg/dL, which was not significantly higher than the baseline level, demonstrating a mostly transient graft dysfunction. CONCLUSIONS Parvovirus B19 is a relatively underreported disease in renal transplant recipients, with patients presenting with anemia and the disease causing transient graft dysfunction. Parvovirus B19 infection responds well to a decrease in immunosuppression and intravenous immunoglobulin therapy.
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Affiliation(s)
- Priyash Tambi
- From the Department of Nephrology and Transplantation, Institute of Kidney Disease and Research Center, Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
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6
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Bertazza Partigiani N, Negrisolo S, Carraro A, Marzenta D, Manaresi E, Gallinella G, Barzon L, Benetti E. Pre-Existing Intrarenal Parvovirus B19 Infection May Relate to Antibody-Mediated Rejection in Pediatric Kidney Transplant Patients. Int J Mol Sci 2023; 24:ijms24119147. [PMID: 37298109 DOI: 10.3390/ijms24119147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/01/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Viral infections can lead to transplant dysfunction, and their possible role in rejection is described. In total, 218 protocol biopsies performed in 106 children at 6, 12 and 24 months after transplantation were analyzed according to Banff '15. RT-PCR for cytomegalovirus, Epstein-Barr virus, BK virus and Parvovirus B19 was performed on blood and bioptic samples at the time of transplant and each protocol biopsy. The prevalence of intrarenal viral infection increases between 6 and 12 months after transplantation (24% vs. 44%, p = 0.007). Intrarenal Parvovirus B19 infection is also associated with antibody-mediated rejection (ABMR) (50% ABMR vs. 19% T-cell-mediated rejection, p = 0.04). Moreover, Parvovirus infection is higher at 12 months of follow-up and it decreases at 48 months (40.4% vs. 14%, p = 0.02), while in 24% of grafts, Parvovirus is already detectable at the moment of transplantation. Intrarenal Parvovirus B19 infection seems to be related to ABMR in pediatric kidney recipients. The graft itself may be the way of transmission for Parvovirus, so performance of a PCR test for Parvovirus B19 should be considered to identify high-risk patients. Intrarenal Parvovirus infection presents mainly during the first-year post-transplantation; thus, we recommend an active surveillance of donor-specific antibodies (DSA) in patients with intrarenal Parvovirus B19 infection during this period. Indeed, it should be considered a treatment with intravenous immunoglobulins in patients with intrarenal Parvovirus B19 infection and DSA positivity, even in the absence of ABMR criteria for kidney biopsy.
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Affiliation(s)
- Nicola Bertazza Partigiani
- Pediatric Nephrology, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy
- Department of Women's and Children's Health, University of Padua, 35128 Padua, Italy
| | - Susanna Negrisolo
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women's and Children's Health, University of Padova, 35127 Padua, Italy
- Pediatric Research Institute "IRP Città della Speranza", 35127 Padua, Italy
| | - Andrea Carraro
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women's and Children's Health, University of Padova, 35127 Padua, Italy
| | - Diana Marzenta
- Pediatric Nephrology, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women's and Children's Health, University of Padova, 35127 Padua, Italy
| | - Elisabetta Manaresi
- Department of Pharmacy and Biotechnology, University of Bologna, 40138 Bologna, Italy
| | - Giorgio Gallinella
- Department of Pharmacy and Biotechnology, University of Bologna, 40138 Bologna, Italy
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy
| | - Elisa Benetti
- Pediatric Nephrology, Department of Women's and Children's Health, University Hospital of Padua, 35128 Padua, Italy
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women's and Children's Health, University of Padova, 35127 Padua, Italy
- Pediatric Research Institute "IRP Città della Speranza", 35127 Padua, Italy
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7
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Russcher A, Molenaar-de Backer M, de Brouwer C, Dijkstra K, Kers J, de Vries A, Zaaijer H, Vossen A, Kroes A. Transient Parvovirus B19 DNAemia After Kidney Transplantation: A 2-Sided Story. Open Forum Infect Dis 2023; 10:ofad079. [PMID: 36879626 PMCID: PMC9984985 DOI: 10.1093/ofid/ofad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Parvovirus B19 (B19V) DNAemia appears to be a relatively common finding after kidney transplantation. However, not all DNAemia signifies active infection with replicating virus. This study screened 134 patients posttransplantation for B19V DNAemia and identified 2 cases in which viral DNA was present after transplantation, with the donor kidney as probable source of the DNA. In both cases intact viral particles could not be detected using an endonuclease method, indicating the presence of noninfectious DNA remnants.
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Affiliation(s)
- Anne Russcher
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijke Molenaar-de Backer
- Donor Medicine Research, Department of Blood-borne Infections, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Caroline de Brouwer
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kyra Dijkstra
- Department of Pathology and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jesper Kers
- Department of Pathology and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Aiko de Vries
- Department of Nephrology and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Zaaijer
- Donor Medicine Research, Department of Blood-borne Infections, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Ann Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aloysius Kroes
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
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8
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Zhang QQ, Zhang WJ, Wang F, Chen S, Chang S. Clinical utility of immune function based on IFN-γ monitoring of lymphocyte subsets for parvovirus B19 infection in renal recipients. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 103:105307. [PMID: 35738549 DOI: 10.1016/j.meegid.2022.105307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There should be a heightened index of suspicion for Parvovirus B19 (PVB19)-related anemia in organ transplant recipients. Thus far, there is no consensus or recommendation for clinical routine monitoring methods of PVB19 recipients to allow tailoring of immunosuppression. METHODS We conducted a retrospective study to evaluate the utility of the function (represented by the abilities to secrete IFN-γ) and numbers of lymphocyte subsets in monitoring PVB19 infections in renal recipients posttransplant. The enrolled 109 patients were split into 2 groups according to whether the recipients had an occurrence of PVB19 infection: 37 (33.94%) recipients developed PVB19 infection and 72 (66.06%) immune-stable recipients. RESULTS The PVB19 infected group had significantly lower absolute counts and functions of different lymphocyte subsets compared with immune-stable recipients. We showed that the frequencies of IFN-γ + CD4 + T cells, IFN-γ + CD8 + T cells, and IFN-γ + NK cells increased markedly after treatment when compared to the occurrence in patients with timepoint before therapy, especially the percentages of IFN-γ + CD4 + T cells were significantly higher. Receiver operating characteristic (ROC) analysis showed that the optimal infection indicator was IFN-γ + NK cells frequency, with an auROC curve of 0.925. Concomitantly, Cox regression analysis indicated that the post-therapy increasing level of IFN-γ secreting function was significantly predictive of recurrent infections (P < 0.001). CONCLUSIONS We recommend prospective risk stratification for the high-risk population at risk of early-onset PVB19 infection and its recurrence involves screening strategies of immune-based surveillance with the sensitive IFN-γ + secreting monitoring for antiviral prophylaxis and preemptive therapy goal. Clinical Trial Notation: clinical trial registration number: chiCTR-ROC-17010756.
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Affiliation(s)
- Qian-Qian Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Wei-Jie Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Sheng Chang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education NHC Key Laboratory of Organ Transplantation Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China.
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9
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Zhou X, Jiang P, Gao L, Yang J, Cai Y, Tong Y, Qiu H, Huang C, Zhou K, Xu X, Niu J, Xia X, Zhang Y, Shen C, Wei Y, Shao J, Song X, Wan L. Immune reconstitution and survival of patients with parvovirus B19 related pure red cell aplasia after haplo-PBSCT. Ann Hematol 2022; 101:1333-1342. [PMID: 35396950 PMCID: PMC9072482 DOI: 10.1007/s00277-022-04831-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022]
Abstract
Parvovirus B19 (PvB19) infection and PvB19 related pure red cell aplasia (PRCA) in recipients with allogeneic hematopoietic stem cell transplantation have been reported sporadically. However, clinical studies with large sample sizes are lacking, especially in patients undergoing HLA-haploidentical peripheral blood stem cell transplantation (haplo-PBSCT). In addition, clinical features, immune reconstitution, and outcomes of these patients are not clear. We conducted a retrospective analysis of 164 patients who received haplo-PBSCT with low-dose anti-thymocyte globulin (ATG) plus low-dose posttransplant cyclophosphamide (PTCy)-based regimen as graft-versus-host disease (GVHD) prophylaxis. We analyzed the incidence of PvB19 related PRCA and compared the clinical characteristics, immune reconstitution, incidence of GVHD, relapse rate, and survival between patients with and without PvB19 related PRCA. A total of 14 (8.5%) recipients developed PvB19 related PRCA after a median of 5.3 months after haplo-PBSCT. These patients with PvB19 related PRCA had slower immune reconstitution, but similar incidences of GVHD, relapse rate, and overall survival compared with recipients without PvB19 related PRCA. PvB19 related PRCA indicated relative delayed and poor immune reconstitution of the recipients early after haplo-PBSCT. PvB19 related PRCA had no effects on GVHD, relapse, and survival.
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Affiliation(s)
- Xiao Zhou
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Peiyao Jiang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Lu Gao
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Jun Yang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Yu Cai
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Yin Tong
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Huiying Qiu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Chongmei Huang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Kun Zhou
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Xiaowei Xu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Jiahua Niu
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Xinxin Xia
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Ying Zhang
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Chang Shen
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Yu Wei
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Jie Shao
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China.,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China
| | - Xianmin Song
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China. .,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China.
| | - Liping Wan
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai, 200080, China. .,Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee (STCSM), No. 100 Haining Road, Shanghai, 200080, China.
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10
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Yu Y, Bao R, Lyu J, Wu J, Chen J, Peng W. Foscarnet Therapy for Pure Red Cell Aplasia Related to Human Parvovirus B19 Infection in Kidney Transplant Recipients: A Preliminary Exploration. Infect Drug Resist 2021; 14:2911-2923. [PMID: 34349526 PMCID: PMC8326942 DOI: 10.2147/idr.s321936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/21/2021] [Indexed: 12/22/2022] Open
Abstract
Background Parvovirus B19-associated pure red cell aplasia (PVB19-PRCA) is an uncommon but serious complication after kidney transplantation. Currently, intravenous immunoglobulin (IVIG) is preferred as the first-line treatment for PVB19-PRCA, but presents with disadvantages of disease recurrence and expensive cost. In this context, we propose that foscarnet therapy for kidney transplantation recipients (KTR) with PVB19-PRCA may be an alternative scenario. No related study has been reported, and we performed this study to assess the efficacy and safety of foscarnet for PVB19-associated PRCA in KTR. Methods We conducted a retrospective review of PVB19-PRCA in KTR at our center over 9-year period. The data on therapy and outcomes in all cases treated with foscarnet are detailed records and summarized. Results Among our 68 patients, PVB19-PRCA was confirmed in 50 based on inclusion/exclusion criteria. All patients presented with refractory anemia and low reticulocyte percentage (<0.5%), the mean hemoglobin of patients was 79.8±12.6g/L at the time of PVB19-PRCA was identified. The median serum genome copy number of parvovirus B19 at diagnosis was 9.6 log10 copies per milliliter. A total of 11 patients received foscarnet therapy, of 10 patients responded well to the treatment and maintained no recurrence. But 1 patient had a poor response to foscarnet therapy. Except for this patient, the mean hemoglobin level gradually increased from 68.5±9.3 g/L to 73.2±8.8 g/L, and the mean percentage of reticulocytes steadily increased from 0.1±0.0% to 7.6±2.9% after foscarnet therapy. The median serum genome copy number of parvovirus B19 decreased from 9.8 log10 to 6.1 log10 copies per milliliter. There was no significant difference (P=0.61, 0.60) in serum creatinine and glomerular filtration rate before and after foscarnet treatment. At the latest follow-up, the mean hemoglobin was 131.5±12.5 g/L and the hemoglobin correction occurred in all patients. Conclusion Foscarnet therapy doesn't seem to be worse than IVIG for PVB19-PRCA in KTR, and it can be an alternative option.
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Affiliation(s)
- Yedong Yu
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ruijie Bao
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Junhao Lyu
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Department of Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Jianyong Wu
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Department of Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Jianghua Chen
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Department of Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
| | - Wenhan Peng
- Department of Kidney Disease Center, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Department of Kidney Disease Immunology Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, People's Republic of China.,Department of Key Laboratory of Multiple Organ Transplantation, Ministry of Health of China, Hangzhou, People's Republic of China.,Institute of Nephropathy, Zhejiang University, Hangzhou, People's Republic of China
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