Parvovirus-B19-associated complications in renal transplant recipients

Nat Clin Pract Nephrol. 2007 Oct;3(10):540-50. doi: 10.1038/ncpneph0609.


Parvovirus B19 is a common human pathogen, causing erythema infectiosum in children, hydrops fetalis in pregnant women, and transient aplastic crisis in patients with chronic hemolytic anemia. Immunosuppressed patients can fail to mount an effective immune response to B19, resulting in prolonged or persistent viremia. Renal transplant recipients can develop symptomatic B19 infections as a result of primary infection acquired via the usual respiratory route or via the transplanted organ, or because of reactivation of latent or persistent viral infection. The most common manifestations of B19 infection in immunosuppressed patients are pure red cell aplasia and other cytopenias. Thus, this diagnosis should be considered in transplant recipients with unexplained anemia and reticulocytopenia or pancytopenia. Collapsing glomerulopathy and thrombotic microangiopathy have been reported in association with B19 infection in renal transplant recipients, but a causal relationship has not been definitively established. Prompt diagnosis of B19 infection in the renal transplant recipient requires a high index of suspicion and careful selection of diagnostic tests, which include serologies and polymerase chain reaction. Most patients benefit from intravenous immunoglobulin therapy and/or alteration or reduction of immunosuppressive therapy. Conservative therapy might be sufficient in some cases.

Publication types

  • Research Support, N.I.H., Intramural
  • Review

MeSH terms

  • Disease Transmission, Infectious
  • Erythema Infectiosum / complications
  • Erythema Infectiosum / diagnosis
  • Erythema Infectiosum / etiology
  • Erythema Infectiosum / therapy
  • Herpesviridae Infections / complications
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects
  • Kidney Transplantation* / adverse effects
  • Postoperative Complications*
  • Red-Cell Aplasia, Pure / virology


  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents