Human pegivirus‐1 infection in kidney transplant recipients: A single‐center experience

Abstract

Kidney transplantation is the treatment of choice for patients with end‐stage renal disease. In the posttransplant period, the induced immunosuppression leads to an increased risk of developing infectious diseases, a leading cause of death after kidney transplantation. Human pegivirus‐1 (HPgV‐1) is considered a nonpathogenic human virus and is highly frequent in individuals parenterally exposed, however, its impact on kidney transplantation outcome is poorly understood. Given the scarcity of epidemiological data for this infection on organ recipients in Brazil, we conducted a study in a single center for kidney transplantation in Rio de Janeiro, aiming to determine HPgV‐1 prevalence and genotypic distribution. Serum samples from 61 renal recipients, followed up for the first year after transplantation, were evaluated for viral RNA and genotypes were determined by sequencing of the 5′‐untranslated region. HPgV‐1 RNA was detected in 36.1% (22/61) of patients. Genotype 2 was the most commonly found (80.9%), followed by genotypes 3 (9.5%), 1, and 5, in 4.8% each. Statistical comparisons did not reveal any significant impact of HPgV‐1 in patient outcome. Further epidemiologic studies are needed to understand if immunosuppression may interfere in HPgV‐1 persistence rates and if viremia might impact graft dysfunction rates in kidney recipients.

Human pegivirus type 1 infection in kidney transplant recipients: Replication kinetics and clinical correlates

“…The prevalence of detectable HPgV-1 RNA by RT-PCR targeting the 5′ UTR in our cohort (26.1%) was in line with rates reported in Brazilian KT recipients (16.7%-36.1%) 23,24 and in HT (36%) and lung transplant (LuT) recipients (18%) from Germany and Austria. 22,37 The corresponding figures in the LT setting seem to be lower (∼14% in studies carried out in Japan 21 and Iran 19 ).…”

“…[14][15][16][17] Not surprisingly, some recent studies have investigated whether this effect may be extrapolated to the SOT and HSCT settings. Nevertheless, no significant differences according to the HPgV-1 RNA status have been observed in terms of graft survival or incidence of rejection among KT recipients, 24 patient survival or graft rejection in HT 45 or LT recipients, 21,45 or occurrence of acute or chronic rejection after LuT. 37 On the other hand, the timing of neutrophil engraftment and cellular immune reconstitution, overall survival and rate of graft-versus-host disease were comparable between…”

“…Rates were calculated by taking the corresponding monitoring point as the beginning of the observation period. HPgV-1, human pegivirus type 1; iRAE, immunosuppression-related adverse event Few previous studies have investigated the clinical features associated with posttransplant HPgV-1 infection, revealing female gender 24 and younger recipient age 37 as risk factors. In our study, recipient age was also lower in the HPgV-1-positive group, although the difference was not maintained in the multivariate model.…”

“…In fact, the only study to date that has performed HPgV-1 genotyping in a small cohort of KT recipients found no association between specific genotypes and clinical variables. 24 The number of iRAE and rejection episodes during late posttransplant periods was low, compromising statistical power. The absence of standardized assays for HPgV-1 detection or external quality assessment pilot programs poses a potential limitation to ours and previous studies, for which some degree of inter-laboratory variability in RNA levels is to be expected.…”

“…12 In view of such intriguing findings involving the HIV population, a few studies have investigated the alleged immunomodulatory effects of HPgV-1 in the setting of solid organ transplantation (SOT), including liver transplant (LT), [19][20][21] heart transplant (HT), 22 and kidney transplant (KT) recipients. 23,24 Other authors have focused on hematopoietic stem cell transplantation (HSCT). 25,26 Nevertheless, most available studies were limited by small sample sizes or imprecise characterization of outcomes.…”