BK Virus and Cytomegalovirus Coinfections in Kidney Transplantation and Their Impact on Allograft Loss

Herrera, Sabina; Bernal-Maurandi, Javier; Cofan, Frederic; Ventura, Pedro; Marcos, María Ángeles; Linares, Laura; Cuesta, G.; Diekmann, Fritz; Moreno, Asunción; Bodro, Marta

doi:10.3390/jcm10173779

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…Our finding that CMV could be related to urological problems is instead uncommon: to the best of our knowledge, this observation was only recently suggested by Herrera et al [ 40 ]. In that study, the authors noted increased nephrostomy requirements in recipients with CMV, leading to their speculation that the need for nephrostomy is more common in patients with post-transplant complications with a heightened state of immunosuppression.…”

Section: Discussionsupporting

confidence: 49%

Relationship between Cytomegalovirus Viremia and Long-Term Outcomes in Kidney Transplant Recipients with Different Donor Ages

et al. 2023

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Objectives: To explore the Cytomegalovirus (CMV) burden on the long-term post-transplant course in different donor ages, we evaluated the incidence and risk factors for CMV in our kidney-transplanted patients (KTs) with extensive adoption of expanded-criteria donors (ECDs). Methods: Retrospective evaluation of 929 consecutive first KTs (49.5% receiving an organ from a donor ≥ 60 years) performed between 01-2003 and 12-2013. Overall survival was estimated using Kaplan–Meier curves; cumulative incidence function was additionally analyzed to consider the potential role of death with a functioning graft as a competitive event with graft dysfunction and to avoid overestimation. Apart from regular DNAemia monitoring in all patients, prophylaxis was adopted in high-risk groups (D+/R− or recipients of anti-thymocyte globulin induction), with pre-emptive therapy in the remaining groups. Results: CMV incidence was 19.5% (4–34.9% according to serostatus combination: D−/R−, D−/R+, D+/R+, D+/R−). Donor and recipient age, recipient pre-transplant hypertension, DR antigen compatibility, cold ischemia time, and post-transplant early complications, including rejection, urologic and renal artery stenosis, and lower renal function and proteinuria ≥ 0.5 g/day at one year after KT were associated with CMV. CMV determined lower death-censored graft survival (DCGS) (p < 0.01), with a prominent effect in R+ (p < 0.01) and without impact in R− (p = 0.32 in D−/R− and p = 0.006 in D+/R−). Interestingly, CMV occurrence influenced DCGS only in KTs who received grafts from donors < 50 or 50–69 years old (p < 0.01), while it was not significant with older donors (p = 0.07). The analysis of the cumulative incidence of graft loss accounting for death as a competing risk confirmed all these findings. In multivariate analysis, CMV replication/disease in the first year was an independent predictor for DCGS (HR 1.73 [1.3–2.3]). Conclusions: In a large population with extensive ECD adoption, CMV viremia in the first year demonstrates its harmful effect with an independent role for graft loss and significant impact among R+ recipients and KTs with donors < 70 years.

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Section: Discussionsupporting

confidence: 49%

Relationship between Cytomegalovirus Viremia and Long-Term Outcomes in Kidney Transplant Recipients with Different Donor Ages

et al. 2023

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“…Post-transplant pyelonephritis is the most common bacterial infection in kidney transplant recipients [ 13 ] and is associated with an increased risk of graft loss and death [ 14 ]. CMV and BK virus infections are the major infection complications in renal transplant recipients [ 15 ]. Viral infections are biomarkers of excessive immunosuppression, and monitoring for reactivation of these viral infections should be routine.…”

Section: Discussionmentioning

confidence: 99%

“…In this case, the TAC trough level was high when CMV colitis occurred, which may suggest the relationship between blood levels of immunosuppressants and CMV colitis. Patients with CMV reactivation should be actively screened for the BK virus [ 15 ]. In this case, we screened for and diagnosed the patient with BK virus infection and reduced immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Adrenal Insufficiency Associated With Empty Sella Syndrome and Steroid Malabsorption Complicated With Septic Shock Due to Post-transplant Pyelonephritis: A Case Report

Shima¹,

Miya²,

Okada³

et al. 2023

Cureus

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Renal transplant recipients are immunocompromised and predisposed to develop hyponatremia because they are exposed to immunological, infectious, pharmacological, and oncologic disorders. A 61-year-old female renal transplant recipient was admitted with diarrhea, anorexia, and headache for about a week during the tapering of oral methylprednisolone for chronic renal allograft rejection. She also presented hyponatremia and was suspected to have secondary adrenal insufficiency based on a low plasma cortisol level of 1.9 μg/dL and a low adrenocorticotropic hormone level of 2.6 pg/mL. Brain magnetic resonance imaging to assess the hypothalamic-pituitary-adrenal axis revealed an empty sella. She also developed septic shock and disseminated intravascular coagulation due to post-transplant pyelonephritis. She had reduced urine output and underwent hemodialysis. Both plasma cortisol and adrenocorticotropic hormone levels were relatively low (5.2 μg/dL and 13.5 pg/mL, respectively), which also suggested adrenal insufficiency. She was treated with hormone replacement therapy and antibiotics, successfully recovered from septic shock, and was withdrawn from dialysis. In empty sella syndrome, the somatotropic and gonadotropic axis are the most affected, followed by the thyrotropic and corticotropic axis. She did not present these abnormalities, which may suggest that empty sella syndrome is a separate pathology, and the axis suppression had occurred due to long-term steroid treatment. Diarrhea due to cytomegalovirus colitis might have induced steroid malabsorption and manifested adrenal insufficiency. Secondary adrenal insufficiency should be investigated as a cause of hyponatremia. It should always be borne in mind that diarrhea during oral steroid treatment may cause adrenal insufficiency associated with steroid malabsorption.

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“…The mean time of BKVN diagnosis in our patients was observed to be 6.8 ± 2.4 months after transplantation, while the graft loss rate was 12.5%. In different studies, graft loss rates have been reported as 40-80% [7][8][9][10][11][12][13][14][15][16] .…”

Section: Discussionmentioning

confidence: 99%

Böbrek nakli hastalarında biyopsi ile kanıtlanmış BK virüs nefropatisi: risk faktörleri, sıklığı ve tedavi yaklaşımı

ALTUN

Ulu

Apaydın³

et al. 2022

Cukurova Medical Journal

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Purpose: BK virus nephropathy (BKVN) is a latent infection and it is closely associated with immunsuppressive therapy. We aimed in this study to evaluate biopsy-proven BKVN and investigate frequency, risk factors and treatment management. Materials and Methods: In this study, 422 kidney transplant recipients were analysed retrospectively between April 2014 and April 2020 for biopsy-proven BK virus nephropathy. Group I included 16 kidney transplant patients with biopsy-proven BK nephropathy and group II included 36 kidney transplant patients with negative BK virus nephropathy. We aimed demographic, clinical features of kidney transplant recipients with BKVN (group I, n: 16 ) and non-BKVN (group II, n:36) were compared and the factors affecting of BKVN. Results: The mean age of grup I and group II were were 41±14.8 years and 39±15.2 respectively. The patients mean follow-up period of 43±11.2 months. Serum creatinine and proteinuria degree were significantly higher in the group with BKVN. In order to reduce the dose of immunosuppression in patients with BKVN, tacrolimus treatment was discontinued in 8 patients, and they were switched to everolimus + MMF + prednisone treatment, leflunamide + MMF + prednisone treatment in 4 patients, and sirolimus + MMF + prednisone treatment in 4 patients. The mean serum creatinine level of the patients who were followed up were observed as 1.78±0.98 mg/dl in group I. Conclusion: In our center, the prevalance of BKVN was found 3.92% during the study period. Reduction of dose immunosuppressive therapy is the most effective treatment. It is thought that there was no differences between Leflunamide and other approaches for treatment. Early diagnosis and screening (frequently intervals) seems to be most effective way for BKVN.

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BK Virus and Cytomegalovirus Coinfections in Kidney Transplantation and Their Impact on Allograft Loss

Cited by 10 publications

References 23 publications

Relationship between Cytomegalovirus Viremia and Long-Term Outcomes in Kidney Transplant Recipients with Different Donor Ages

Relationship between Cytomegalovirus Viremia and Long-Term Outcomes in Kidney Transplant Recipients with Different Donor Ages

Adrenal Insufficiency Associated With Empty Sella Syndrome and Steroid Malabsorption Complicated With Septic Shock Due to Post-transplant Pyelonephritis: A Case Report

Böbrek nakli hastalarında biyopsi ile kanıtlanmış BK virüs nefropatisi: risk faktörleri, sıklığı ve tedavi yaklaşımı

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