Outcomes of patients with rejection post-polyomavirus nephropathy

Transplant Proc. 2005 Mar;37(2):942-4. doi: 10.1016/j.transproceed.2004.12.098.

Abstract

Introduction: We sought to determine the effects of rejection in renal transplant recipients with polyomavirus nephropathy (PVN).

Methods: SCr, biopsy findings, BKV serum and urine loads (Taqman PCR), and BKV antibody titers (HA inhibition assay) were analyzed by two-sample median tests and z tests in 11 patients with median follow-up of 7.3 (2.0 to 31.5) months post-PVN. All patients underwent immunosuppression reduction (ISR) as PVN treatment.

Results: Post-PVN, 3 (27%) patients had five rejection episodes, with 80% being mild. Median time to rejection was 18 (2 to 60) weeks. One hundred percent of patients who experienced post-PVN rejection also experienced rejection pre-PVN. Rejection episode treatments consisted of: none in one, increased tacrolimus in two, IVIG in one, IVIG and increased tacrolimus in one. Median viral loads in patients with post-PVN rejection versus those without rejection were not different in serum (2.01 x 10(4) vs 9.00 x 10(4) BKV copies/mL; P = .22) or urine (5.37 x 10(5) vs 8.93 x 10(6) BKV copies/mL; P = .28). Median BKV antibody titers were slightly lower (16384 vs 32768 HA units; P = .02) and median SCr values were significantly higher (2.7 vs 1.9 mg/dL, P = .0003) in patients who had experienced post-PVN rejection. Graft losses occurred in one rejection-free patient (chronic allograft nephropathy) and in one patient who experienced multiple acute rejection episodes, humoral rejection, and worsening PVN.

Conclusions: Patients who experience rejection prior to PVN are at high risk of developing rejection post-ISR and post-PVN; however, low graft loss rates may still be achieved.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biopsy
  • Creatinine / blood
  • Drug Therapy, Combination
  • Graft Rejection / drug therapy*
  • Graft Rejection / epidemiology
  • Graft Rejection / pathology*
  • Graft Rejection / virology
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Kidney Diseases / pathology
  • Kidney Diseases / virology*
  • Kidney Transplantation / pathology*
  • Polyomavirus / genetics
  • Polyomavirus / isolation & purification
  • Polyomavirus Infections / pathology*
  • Risk Factors
  • Treatment Failure
  • Treatment Outcome
  • Viral Load

Substances

  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents
  • Creatinine