JC polyomavirus replication and associated disease in pediatric renal transplantation: an international CERTAIN Registry study

Pediatr Nephrol. 2018 Dec;33(12):2343-2352. doi: 10.1007/s00467-018-4029-9. Epub 2018 Jul 30.

Abstract

Background: JC polyomavirus (JCPyV)-associated nephropathy (JCPyVAN) is a severe, but rare complication in adult renal transplant (RTx) recipients. Related data in pediatric patients are scarce.

Methods: Based on the CERTAIN Registry, we therefore performed a multi-center, retrospective study on the JCPyV antibody status, prevalence of JCPyV replication, and its associated disease in 139 pediatric RTx recipients (mean age, 8.5 ± 5.3 years). JCPyV DNA in plasma and/or urine was measured by quantitative PCR at a median time of 3.2 (IQR, 0.3-8.1) years post-transplant.

Results: 53.2% of patients were JCPyV-seronegative prior to transplantation; younger age was associated with JCPyV seronegativity. 34/139 (24.5%) patients post-transplant showed active JCPyV replication in either urine (22.0%), plasma (13.4%), or both (7.6%). JCPyV viremia occurred significantly (p < 0.001) more often in patients with viruria (34.6%) than in those without (7.6%), but 7/118 (5.9%) had isolated viremia. High-level viruria (> 107 copies/mL) was found in 29.6% of viruric patients. A higher net state of immunosuppression constituted an independent risk factor for JCPyV replication both in urine and plasma (OR 1.2, p < 0.02). Male patients tended to have a higher risk of JCPyV viremia than females (OR 4.3, p = 0.057). There was one male patient (0.7%) with JCPyVAN 7 years post-transplant, which resolved after reduction of immunosuppressive therapy. No patient exhibited progressive multifocal leukoencephalopathy.

Conclusions: This first multi-center study on JCPyV in pediatric renal transplant recipients shows that JCPyV replication is common (24.5%), with strong immunosuppression being a significant risk factor, but associated nephropathy is rare.

Keywords: JC polyomavirus; JC virus; Nephropathy; Pediatric kidney transplantation; Pediatric renal transplantation; Polyomavirus.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control
  • Humans
  • Immunosuppression / adverse effects
  • JC Virus / isolation & purification*
  • Kidney Diseases / epidemiology*
  • Kidney Diseases / immunology
  • Kidney Diseases / virology
  • Kidney Transplantation / adverse effects*
  • Male
  • Polyomavirus Infections / epidemiology*
  • Polyomavirus Infections / immunology
  • Polyomavirus Infections / virology
  • Prevalence
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Transplant Recipients / statistics & numerical data
  • Viremia / epidemiology*
  • Viremia / immunology
  • Viremia / virology