Outcome of renal transplant recipients with cytomegalovirus and BK polyomavirus co-infection nephropathy

Abstract

Reactivation of cytomegalovirus (CMV) and BK polyomavirus (BKV) can result in virus-associated tubulointerstitial nephritis in renal allografts. All those renal biopsies reported as viral cytopathic were isolated and examined by two independent renal histopathologists from our institute and classified as CMV, BKV, and CMV-BKV coinfection-associated viral cytopathic changes with confirmation through polymerase chain reaction technology in either serum or urine or both. All twenty patients were categorized as 10 in CMV, four in BKV, and six were in CMV-BKV coinfection. One patient each had received antithymocyte globulin and basiliximab as induction all patients received triple-drug immunosuppression. The mean graft survival was 69, 61, and 59 months in CMV, BKV, and CMV-BKV coinfection group, respectively. At the end of the study period, 10 (50%) patients died. 1-, 3-and 5-year patient survival was 94%, 88% and 76% among CMV group, 75%, 75% and 50% in BKV group, and 96%, 83% and 62%, in CMV-BKV coinfection group (P = 0.157). CMV and BK virus are not so common infections in postrenal transplant patients yet an important cause of graft dysfunction. Coinfection did not pose an increased risk for acute rejection or patients and death-censored and uncensored graft survival among compared groups.

Clinical features of BK-polyomavirus and cytomegalovirus co-infection after kidney transplantation

“…A possible explanation for these observations could be that, for example, the absolute number of invasive infections such as BK nephropathy in our center is < 10% of patients with BKPyV DNAemia 21 , 30 . Nevertheless, in agreement with Blazquez-Navarro and Kaul et al we observed that patients with co-infections had a worse renal graft function compared to non-infected or single virus infected patients 12 , 35 . Ultimately, we cannot know for certain whether the reduced graft function of patients with co-infection results from the co-infection itself or is biased by the more frequent occurrence of rejection episodes.…”

“…In line with the data, Kaul et al found in an analysis of tissue-invasive CMV-BKPyV co-infections in renal transplants biopsies that coinfected grafts had an inferior function. Interestingly, coinfection had no effect on patient and graft survival 35 . This is somehow surprising since an impact on allograft survival has been reported previously for single virus infections by others 15 , 36 , 37 .…”

AKI and Transaminitis in a Kidney Transplant Patient

“… 1 Only small retrospective case series have reported outcomes of patients infected with both viruses. 2 , 3 Jehn et al 2 compared the outcomes of kidney transplant recipients presenting with concomitant BKPyV and CMV viremia ( n =59), CMV viremia alone ( n =182), and BKPyV viremia alone ( n =102). They found a strong association between coinfection and occurrence of acute rejection.…”

Risk factors and outcome of concurrent and sequential multiviral cytomegalovirus, Epstein–Barr virus, BK virus, adenovirus and other viral reactivations in transplantation

“…Biopsy-proven rejection was higher in patients with CMV/BKV coinfection compared with those with mono-infection (59.3% coinfection vs. 44.1% BKV+, 41.5% CMV+) [16 ▪▪ ]. Long-term graft and patient survival were not significantly affected, though follow-up varied between studies [14,15,16 ▪▪ ]. Studies reporting outcomes are summarized in Table 2.…”

“…BKV and EBV have also been implicated [9][10][11][12][13]. Incidence rates up to 42% have been reported for at least two viruses [9][10][11][12]14,15].…”