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| Polyomavirus-associated nephropathy in renal transplantation: Interdisciplinary analyses and recommendations |
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| Author(s): Hirsch HH, Brennan DC, Drachenberg CB, Ginevri F, Gordon J, Limaye AP, Mihatsch MJ, Nickeleit V, Ramos E, Randhawa P, Shapiro R, Steiger J, Suthanthiran M, Trofe J |
| Source: TRANSPLANTATION Volume: 79 Issue: 10 Pages: 1277-1286 Published: MAY 27 2005 |
| Times Cited: 217 References: 82 |
| Abstract: Polyomavirus-associated nephropathy (PVAN) is an emerging cause of kidney transplant failure affecting 1-10% of patients. As uncertainty exists regarding risk factors, diagnosis and intervention, an independent panel of experts reviewed the currently available evidence and prepared this report. Most cases of PVAN are elicited by BK virus (BKV) in the context of intense immunosuppression. No specific immunosuppressive drug is exclusively associated with PVAN, but most cases reported to date arise while the patient is on triple immunosuppressive combinations, often comprising tacrolimus and/or mycophenolate mofetil plus corticosteroids. Immunologic control of polyomavirus replication can be achieved by reducing, switching, and/or discontinuing components of the immunosuppressive regimen, but the individual's risk of rejection should be considered. The success rate of this intervention is increased with earlier diagnosis. Therefore, it is recommended that all renal transplant recipients should be screened for BKV replication in the urine: 1) every three months during the first two years posttransplant; 2) when aRograft dysfunction is noted; and 3) when allograft biopsy is performed. A positive screening result should be confirmed in < 4 weeks and assessed by quantitative assays (e.g. BKV DNA or RNA load in plasma or urine). Definitive diagnosis of PVAN requires allograft biopsy. If PVAN and concurrent acute rejection is diagnosed, antirejection treatment should be considered, coupled with subsequently reducing immunosuppression. The antiviral cidofovir is not approved for PVAN, but investigational use at low doses (0.25-0.33 mg/kg intravenously biweekly) without probenicid should be considered for refractory cases. Retransplantation after renal allograft loss to PVAN remains a treatment option for patients clearing polyomavirus replication. |
| Document Type: Article |
| Language: English |
| Reprint Address: Hirsch, HH (reprint author), Univ Basel, Inst Med Microbiol, Peterspl 10, CH-4003 Basel, Switzerland |
Addresses:
1. Univ Spital Basel, Inst Med Microbiol, Basel, Switzerland
2. Univ Spital Basel, Div Infect Dis, Basel, Switzerland
3. Univ Spital Basel, Inst Pathol, Basel, Switzerland
4. Univ Spital Basel, Div Transplantat Immunol & Nephrol, Basel, Switzerland
5. Washington Univ, Sch Med, Dept Internal Med, St Louis, MO 63110 USA
6. Univ Maryland, Sch Med, Dept Pathol, Baltimore, MD 21201 USA
7. G Gaslini Inst Children, Pediat Nephrol Unit, Genoa, Italy
8. Temple Univ, Ctr Neurovirol & Canc Biol, Philadelphia, PA 19122 USA
9. Univ Washington, Dept Lab Med, Med Ctr, Seattle, WA 98195 USA
10. Univ N Carolina, Nephropathol Lab, Chapel Hill, NC USA
11. Univ Maryland Hosp, Div Nephrol, Baltimore, MD 21201 USA
12. Univ Pittsburgh, Med Ctr, Dept Pathol, Pittsburgh, PA USA
13. Univ Pittsburgh, Med Ctr, Dept Kidney Pancreas & Islet Transplantat, Pittsburgh, PA USA
14. Cornell Univ, New York Presbyterian Hosp, Dept Med, New York, NY USA
15. Cornell Univ, New York Presbyterian Hosp, Dept Transplantat Med, Weill Med Coll, New York, NY USA
16. Univ Cincinnati, Dept Surg, Div Transplantat, Cincinnati, OH 45267 USA |
| Publisher: LIPPINCOTT WILLIAMS & WILKINS, 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA |
| Subject Category: Immunology; Surgery; Transplantation |
| IDS Number: 929WL |
| ISSN: 0041-1337 |
| DOI: 10.1097/01.TP.0000156165.83160.09 |
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