Cytomegalovirus‐Induced Glomerular Vasculopathy in Renal Allografts: A Report of Two Cases

Onuigbo, Macaulay; Haririan, Abdolreza; Ramos, Emilio; Klassen, David K.; Wali, Ravinder K.; Drachenberg, C. B.

doi:10.1034/j.1600-6143.2002.20717.x

Cited by 27 publications

(20 citation statements)

References 16 publications

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“…Of note, histopathological grading (Table 4) might overestimate rejection especially in desensitized animals as CMV nephritis can show signs that are indistinguishable from rejection (eg, glomerulitis, peritubular capillaritis, tubulitis, etc). [42][43][44][45][46][47] It has been reported that CMV tends to affect kidneys in one of three patterns, (a) CMV infection within the glomerular endothelial cells, (b) CMV infection within the tubular epithelia cells, or (c) CMV in endothelial cells of a peritubular capillary. Interestingly, we exclusively observe peritubular capillary CMV in the desensitized animals ( Figure 4B).…”

Section: Discussionmentioning

confidence: 99%

Dual targeting: Combining costimulation blockade and bortezomib to permit kidney transplantation in sensitized recipients

Burghuber

Manook

Ezekian

et al. 2019

American Journal of Transplantation

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Previous evidence suggests that a homeostatic germinal center (GC) response may limit bortezomib desensitization therapy. We evaluated the combination of costimulation blockade with bortezomib in a sensitized non-human primate kidney transplant model. Sensitized animals were treated with bortezomib, belatacept, and anti-CD40 mAb twice weekly for a month (n = 6) and compared to control animals (n = 7). Desensitization therapy-mediated DSA reductions approached statistical significance (P = .07) and significantly diminished bone marrow PCs, lymph node follicular helper T cells, and memory B cell proliferation. Graft survival was prolonged in the desensitization group (P = .073). All control animals (n = 6) experienced graft loss due to antibody-mediated rejection (AMR) after kidney transplantation, compared to one desensitized animal (1/5). Overall, histological AMR scores were significantly lower in the treatment group (n = 5) compared to control (P = .020). However, CMV disease was common in the desensitized group (3/5). Desensitized animals were sacrificed after long-term follow-up with functioning grafts. Dual targeting of both plasma cells and upstream GC responses successfully prolongs graft survival in a sensitized NHP model despite significant infectious complications and drug toxicity. Further work is planned to dissect underlying mechanisms, and explore safety concerns.

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Section: Discussionmentioning

confidence: 99%

Dual targeting: Combining costimulation blockade and bortezomib to permit kidney transplantation in sensitized recipients

Burghuber

Manook

Ezekian

et al. 2019

American Journal of Transplantation

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“…Tubulointerstitial nephritis caused by CMV is the more common manifestation in renal allograft . CMV glomerulopathy, which can occur with or without concomitant tubulointerstitial disease, has been reported . A case of CMV‐induced necrotizing and crescentic glomerulonephritis in renal transplant patient has been described .…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus renal infection: Rare manifestation of a common post‐transplant viral infection—A case series

Salas

Thompson

Kadian

et al. 2019

Transplant Infectious Dis

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Cytomegalovirus is the most common viral infection in organ transplant recipients that usually affects the brain, lungs, liver, and gastrointestinal tract. Renal involvement of Cytomegalovirus (CMV) is otherwise rare. We present six cases of biopsy‐proven CMV renal infection. Five out of the six patients had detectable CMV viremia. Kidney biopsy revealed glomerulopathy in four cases and tubulointerstitial involvement in two cases. All patients exhibited decline in renal function at the onset of infection. Four out of six patients had improvement of renal function following treatment of CMV disease. To date, this is the largest case series of pure biopsy‐proven CMV renal infection described in a single center.

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“…HCMV infection of the kidney may also result in direct endothelial injury, with subsequent HCMV glomerulopathy [36,38]. A prompt decline in serum creatinine levels after institution of intravenous ganciclovir (without anti‐rejection therapy) has also been described in patients with HCMV glomerulopathy, but without tubulointerstitial changes [38]. In the study of Boyce et al.…”

Section: The Impact Of Hcmv Infection and Disease On Acute Rejection mentioning

confidence: 99%

The impact of early cytomegalovirus infection and disease in renal transplant recipients

Sagedal

Hartmann

Rollag

2005

Clinical Microbiology and Infection

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Human cytomegalovirus (HCMV) infection is the single most frequent infectious complication in the early period after kidney transplantation. The HCMV load in blood, measured by HCMV PCR or the HCMV pp65 antigen test, is a predictor of HCMV disease in seropositive recipients. However, plasma virus load measurements are of only modest value in predicting the risk of HCMV disease in seronegative recipients of kidneys from seropositive donors. HCMV infection is an independent risk-factor for acute kidney graft rejection. There is also evidence that HCMV is associated with an increased long-term mortality and post-transplant diabetes mellitus. Whether pre-emptive or prophylactic therapy should be the preferred strategy is not yet decided. Some studies indicate that HCMV prophylaxis may reduce the risk of acute rejection, and thereby increase long-term graft survival in seronegative recipients of kidneys from seropositive donors.

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Cytomegalovirus‐Induced Glomerular Vasculopathy in Renal Allografts: A Report of Two Cases

Cited by 27 publications

References 16 publications

Dual targeting: Combining costimulation blockade and bortezomib to permit kidney transplantation in sensitized recipients

Dual targeting: Combining costimulation blockade and bortezomib to permit kidney transplantation in sensitized recipients

Cytomegalovirus renal infection: Rare manifestation of a common post‐transplant viral infection—A case series

The impact of early cytomegalovirus infection and disease in renal transplant recipients

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