CMV, EBV, JCV and BKV infection and outcome following kidney transplantation in children initiated on a corticosteroid-minimisation immunosuppressive regimen

McCaffrey, James; Bhute, Vijesh J.; Shenoy, Mohan

doi:10.1007/s00467-021-05047-2

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…Evidence of EBV DNAemia in pediatric kidney transplant is reported to range between 20% and 60%. 65,66,[86][87][88] Controversial findings have been reported regarding risk of rejection and graft survival. 87,[89][90][91] In a large, multicenter prospective trial on the epidemiology of EBV infection including over 100 pediatric kidney transplant recipients, EBV DNAemia was evaluated in the whole blood at 6 wk then every 3 mo during the first-y posttransplant.…”

Section: Kidney Transplantmentioning

confidence: 99%

Screening and Management of PTLD

Zaffiri

Chambers

2023

Transplantation

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Posttransplant lymphoproliferative disorder (PTLD) represents a heterogeneous group of lymphoproliferative diseases occurring in the setting of immunosuppression following hematopoietic stem cells transplant and solid organ transplantation. Despite its overall low incidence, PTLD is a serious complication following transplantation, with a mortality rate as high as 50% in transplant recipients. Therefore, it is important to establish for each transplant recipient a personalized risk evaluation for the development of PTLD based on the determination of Epstein-Barr virus serostatus and viral load following the initiation of immunosuppression. Due to the dynamic progression of PTLD, reflected in the diverse pathological features, different therapeutic approaches have been used to treat this disorder. Moreover, new therapeutic strategies based on the administration of virus-specific cytotoxic T cells have been developed. In this review, we summarize the available data on screening and treatment to suggest a strategy to identify transplant recipients at a higher risk for PTLD development and to review the current therapeutic options for PTLD.

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Section: Kidney Transplantmentioning

confidence: 99%

Screening and Management of PTLD

Zaffiri

Chambers

2023

Transplantation

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“…The time period in which kidney transplant recipients are at the highest risk of primary CMV infection or reactivation correlates with the time period of peak immunosuppression, the first 100 days following transplant [37 ▪▪ ,38,39]. CMV infection can present as asymptomatic viremia, nonspecific viral symptoms, or tissue-invasive disease.…”

Section: Causes For Allograft Dysfunctionmentioning

confidence: 99%

“…An estimated 10-30% of paediatric renal transplant recipients will develop BK viremia, most commonly in the first six months following transplantation. Around 2-8% develop BK nephropathy that can lead to premature graft failure [39,43,44]. As infection is most common in the months immediately following transplant, guidelines recommend screening more frequently shortly after transplantation and spacing the screening intervals thereafter.…”

Section: Infectiousmentioning

confidence: 99%

Approach to acute kidney injury following paediatric kidney transplant

Atlas-Lazar

Erez

2023

Current Opinion in Pediatrics

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Purpose of reviewIn a child with evidence of acute kidney injury (AKI) following renal transplantation, it is important to quickly and accurately diagnose the cause to enable timely initiation of therapeutic interventions. The following article will discuss the differential diagnosis of acute graft dysfunction in paediatric kidney transplant recipients. This review will systematically guide the clinician through the common and less common causes and provide updates on current treatments.Recent findingsIn patients with signs of graft dysfunction, rejection is an important cause to consider. Diagnosis of rejection relies on biopsy findings, an invasive and costly technique. Over the past 5 years, there has been a focus on noninvasive methods of diagnosing rejection, including serum and urinary biomarkers.SummaryThis review discusses the differential diagnosis of acute graft dysfunction following transplant, with a focus on acute rejection, urinary tract infections and common viral causes, prerenal and postrenal causes, nephrotoxic medications, specifically calcineurin inhibitor toxicity, thrombotic microangiopathy and recurrence of the underlying disease. Each condition is discussed in detail, with a focus on clinical clues to the cause, incidence in the paediatric population, workup and treatment.

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Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort

Pullerits

Garland

Rengarajan

et al. 2022

Viruses

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Background: Opportunistic infections remain a significant cause of morbidity and mortality after kidney transplantation. This retrospective cohort study aimed to assess the incidence and predictors of post-transplant DNA virus infections (CMV, EBV, BKV and JCV infections) in kidney transplant recipients (KTR) at a single tertiary centre and evaluate their impact on graft outcomes. Methods: KTR transplanted between 2000 and 2021 were evaluated. Multivariate logistic regression analysis and Cox proportional hazard analyses were used to identify factors associated with DNA virus infections and their impact on allograft outcomes respectively. A sub-analysis of individual viral infections was also conducted to describe the pattern, timing, interventions, and outcomes of individual infections. Results: Data from 962 recipients were evaluated (Mean age 47.3 ± 15 years, 62% male, 81% white). 30% of recipients (288/962) had infection(s) by one or more of the DNA viruses. Individually, CMV, EBV, BKV and JCV viruses were diagnosed in 13.8%. 11.3%, 8.9% and 4.4% of recipients respectively. Factors associated with increased risk of post-transplant DNA virus infection included recipient female gender, higher number of HLA mismatch, lower baseline estimated glomerular filtration rate (eGFR), CMV seropositive donor, maintenance with cyclosporin (rather than tacrolimus) and higher number of maintenance immunosuppressive medications. The slope of eGFR decline was steeper in recipients with a history of DNA virus infection irrespective of the virus type. Further, GFR declined faster with an increasing number of different viral infections. Death-censored graft loss adjusted for age, gender, total HLA mismatch, baseline eGFR and acute rejection was significantly higher in recipients with a history of DNA virus infection than those without infection (adjusted hazard ratio (aHR, 1.74, 95% CI, 1.08–2.80)). In contrast, dialysis-free survival did not differ between the two groups of recipients (aHR, 1.13, 95% CI, 0.88–1.47). Conclusion: Post-transplant DNA viral infection is associated with a higher risk of allograft loss. Careful management of immunosuppression and close surveillance of at-risk recipients may improve graft outcomes.

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CMV, EBV, JCV and BKV infection and outcome following kidney transplantation in children initiated on a corticosteroid-minimisation immunosuppressive regimen

Cited by 4 publications

References 29 publications

Screening and Management of PTLD

Screening and Management of PTLD

Approach to acute kidney injury following paediatric kidney transplant

Kidney Transplant-Associated Viral Infection Rates and Outcomes in a Single-Centre Cohort

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