BKV in Simultaneous Pancreas-Kidney Transplant Recipients: A Leading Cause of Renal Graft Loss in First 2 Years Post-Transplant

Abstract

With the introduction of more potent immunosuppressive agents, rejection has decreased in simultaneous pancreas/kidney transplant (SPK) recipients. However, as a consequence, opportunistic infections have increased. The purpose of this report is to outline the course of SPK patients who developed polyomavirusassociated nephropathy (PVAN). A retrospective review of 146 consecutive SPK recipients from January 1, 1996 to December 31, 2002 was performed. Immunosuppression, rejection and development of PVAN were reviewed. Nine patients were identified. All received induction with either OKT3 or thymoglobulin. Immunosuppression included tacrolimus/cyclosporine, MMF/azathioprine and sirolimus/prednisone. Two patients were treated for kidney rejection prior to the diagnosis of PVAN. Time to diagnosis was an average of 359.3 days post-transplantation. Immunosuppression was decreased but five ultimately lost function. However, none developed pancreatic abnormalities as demonstrated by normal glucose and amylase. Two underwent renal retransplantation after PVAN diagnosis and both have normal kidney function. PVAN was the leading cause of renal loss in SPK patients in the first 2 years after transplantation and is a serious concern for SPK recipients. The pancreas, however, is spared from evidence of infection, and no pancreatic rejection occurred when immunosuppression was decreased.

Kidney Transplant Function and Histological Clearance of Virus Following Diagnosis of Polyomavirus-Associated Nephropathy (PVAN)

“…A number of published reports describe cases of PVAN treated intermittently with cidofovir at 0.25-3.0 mg/kg (2,23,24,26,27,41). Resolution of viremia and reduction of urinary viral load have been documented-typically occurring gradually over several months.…”

“…In some reports, stabilization of S Cr was observed in patients for whom prior immunosuppression reduction was associated with ongoing functional decline (24,26,27). In others, however, reduced immunosuppression and cidofovir were initiated simultaneously or functional decline occurred despite cidofovir therapy (2,41). Recently, Kuypers et al compared outcomes for 8 PVAN cases managed by immunosuppression reduction and cidofovir with those of a group managed by immunosuppression reduction alone (25).…”

BK Virus Nephropathy and Kidney Transplantation

“…Tubulointerstitial damage from direct and indirect effects of the virus and rejection after immunosuppression reduction lead to early graft loss or chronic dysfunction (46,48,51,53,80,86,94,95,124). In recipients who have advanced kidney disease or who have returned to dialysis from BKV nephropathy, retransplantation has been successful (125)(126)(127)(128)(129)(130). In most cases, transplant nephrectomy and/or studies to confirm no active viral replication have been performed.…”

BK Virus Associated Late Onset Haemorrhagic Cystitis After Allogeneic Peripheral Blood Stem Cell Transplant

“…After the primary infection has occurred latency is established in renal tissues and circulating B lymphocytes [10]. BKV nephropathy and graft dysfunction is a significant problem in solid organ transplantation and has been well documented in pancreas-kidney recipients [11]. Late onset HC in recipients of stem cell transplant is generally associated with a viral infection and polyoma BKV and cytomegalovirus are the most common pathogens implicated [12].…”