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BK Virus Infection After Kidney Transplantation

Prasad Nair, Osama Gheith, Torki Al-Otaibi, Mohamed Mostafa, Suzann Rida, Islam Sobhy, Medhat A Halim, Tarek Mahmoud, Mohamed Abdul-Hameed, Ayman Maher, Mohamed Emam
OBJECTIVES: Data on the management of chronic antibody-mediated rejection after kidney transplantation are limited. We aimed to assess the impact of treatment of biopsy-proven chronic active antibodymediated rejection with combined plasma exchange, intravenous immunoglobulin, and rituximab treatment versus intravenous immunoglobulin alone or conservative management on the evolution of renal function in renal transplant recipients. MATERIALS AND METHODS: In this retrospective study, we compared patients diagnosed with chronic active antibody-mediated rejection who were treated with standard of care steroids, intravenous immunoglobulin, plasma exchange, and rituximab (n = 40) at our center versus those who received intravenous immunoglobulin only or just intensified maintenance immunosuppression (n = 28)...
January 2019: Experimental and Clinical Transplantation
Neda Zareei, Hamid Reza Miri, Mohammad Hossein Karimi, Afsoon Afshari, Bita Geramizadeh, Jamshid Roozbeh, Ramin Yaghobi
Polyomavirus BK infection is a common complication and a major cause of morbidity after kidney transplantation. Surveillance of kidney transplant recipients was threatened by reactivation of polyomavirus BK infection can lead to polyomavirus BK-associated nephropathy (PVN). Antiviral immunoregulatory markers like Gamma interferon (IFN-γ) might also affect the polyomavirus BK pathogenesis for its role in antiviral host defense, graft rejection, and regulative of the adaptive immune responses. After screening polyomavirus BK infection, using Real time PCR (Taq-Man), the possible association between polyomavirus BK infection with IFN-γ gene expression was assessed...
February 12, 2019: Microbial Pathogenesis
Evaldo Favi, Carmelo Puliatti, Rajesh Sivaprakasam, Mariano Ferraresso, Federico Ambrogi, Serena Delbue, Federico Gervasi, Ilaria Salzillo, Nicholas Raison, Roberto Cacciola
BACKGROUND: Polyomavirus-associated nephropathy is a leading cause of kidney allograft failure. Therapeutic options are limited and prompt reduction of the net state of immunosuppression represents the mainstay of treatment. More recent application of aggressive screening and management protocols for BK-virus infection after renal transplantation has shown encouraging results. Nevertheless, long-term outcome for patients with BK-viremia and nephropathy remains obscure. Risk factors for BK-virus infection are also unclear...
February 6, 2019: World Journal of Clinical Cases
Yi Zhou, Leiyu Yao, Zhe Yu, Naiqian Cui, Fangxiang Fu, Yuedian Ye, Wenfeng Deng, Jian Xu, Shaojie Fu, Ruming Liu, Lixin Yu, Yun Miao
OBJECTIVE: To analyze the characteristics of BK polymavirus (BKV) infection and the optimal time window for intervention in kidney transplant recipients (KTRs). METHODS: We retrospectively analyzed the clinical data and treatment regimens in 226 KTRs in our center between January, 2013 and January, 2018. Among the recipients, 157 had a urine BKV load ≥1.0×104 copy/mL after transplantation, and 69 had a urine BKV load below 1.0×104 copy/mL (control group). RESULTS: Among the 157 KTRs, 60 (38...
January 30, 2019: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
Paulo Roberto P Urbano, Luiz H da Silva Nali, Renato Dos R Oliveira, Laura M Sumita, Maria Cristina D da Silva Fink, Lígia C Pierrotti, Camila da Silva Bicalho, Elias David-Neto, Cláudio S Pannuti, Camila M Romano
BK virus is the causative agent of polyomavirus-associated nephropathy, a major cause of kidney transplant failure affecting 1-10% of recipients. Previous studies that investigated the viral source on the kidney recipient pointed that the donor is implicated in the origin of BKPyV infection in recipients, but giving the low genetic variability of BKPyV this subject is still controversial. The aim of this study was to determine if BKPyV replicating in kidney recipients after transplantation is always originated from the donor...
January 24, 2019: Journal of Medical Virology
Jakapat Vanichanan, Suwasin Udomkarnjananun, Yingyos Avihingsanon, Kamonwan Jutivorakool
Infectious complications have been considered as a major cause of morbidity and mortality after kidney transplantation, especially in the Asian population. Therefore, prevention, early detection, and prompt treatment of such infections are crucial in kidney transplant recipients. Among all infectious complications, viruses are considered to be the most common agents because of their abundance, infectivity, and latency ability. Herpes simplex virus, varicella zoster virus, Epstein-Barr virus, cytomegalovirus, hepatitis B virus, BK polyomavirus, and adenovirus are well-known etiologic agents of viral infections in kidney transplant patients worldwide because of their wide range of distribution...
December 2018: Kidney Research and Clinical Practice
Alžběta Hejtmánková, Kateřina Roubalová, Alena Forejtová, Jiřina Žáčková Suchanová, Jitka Forstová, Ondřej Viklický, Hana Španielová
Active infection with BK polyomavirus (BKPyV) may cause serious complications in transplantation settings. Recently, level of BKPyV IgG seroreactivity in graft donors has been shown to predict viremia and BKPyV-associated nephropathy in kidney transplant (KTx) recipients. Pre-transplantation testing of donor and recipient BKPyV serostatus could therefore identify high-risk patients. For the development of serological immunoassays, antibody response to the predominant BKPyV subtypes (BKPyV-I and BKPyV-IV) was studied using virus-like particle (VLP)-based ELISA...
January 4, 2019: Journal of Medical Virology
Ibai Los-Arcos, Oscar Len, Manel Perello, Irina B Torres, Gemma Codina, Juliana Esperalba, Joana Sellarés, Francesc Moreso, Daniel Seron, Joan Gavaldà
BACKGROUND: Data are scarce on cytomegalovirus (CMV) and BK virus (BKV) infection after antibody-mediated rejection (ABMR). OBJECTIVES: We hypothesized that the immunological response in patients with ABMR or the immune modulation associated with its treatment could predispose to CMV and BKV infection. Our objective was to investigate this hypothesis. STUDY DESIGN: We conducted a single-center, matched case-control study (1:2 ratio) to analyze CMV and BKV replication during the first year after the ABMR diagnosis in kidney transplant recipients...
December 1, 2018: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
Yeonhee Lee, Yae-Jean Kim, Heeyeon Cho
BK virus is a known cause of renal failure in kidney transplant recipients, but there is little data regarding its effect on native kidneys in heart transplant patients. Here, we describe the case of a child who underwent heart transplantation and was later diagnosed with BK virus with multiorgan involvement. This patient was diagnosed with dilated cardiomyopathy at 4 months of age and underwent heart transplantation at the age of 5 years. Before transplantation, the patient suffered from cardiac arrest and fungal pyelonephritis...
February 2019: Clinical Nephrology
Jenni Miettinen, Irmeli Lautenschlager, Fabian Weissbach, Marion Wernli, Eeva Auvinen, Laura Mannonen, Jouni Lauronen, Hans H Hirsch, Hannu Jalanko
BACKGROUND: BKPyV is an important cause of premature graft failure after KT. Most clinical studies describe BKPyV infection in adult KT patients. We studied the prevalence of post-transplant BKPyV viremia, serology, and graft function in pediatric KT recipients. METHODS: Forty-six pediatric patients transplanted between 2009 and 2014 were followed up for BKPyV DNAemia by plasma PCR for median 2.3 (range: 1-6) years. BKPyV-specific antibodies were retrospectively analyzed using virus-like particle ELISA...
November 16, 2018: Pediatric Transplantation
Fangxiang Fu, Wenfeng Deng, Siyuan Yu, Yanna Liu, Lixin Yu, Rumin Liu, Jiping Lang, Dianxiang Geng, Jian Geng, Jiangtao Li, Gang Huang, Minhua Luo, Fu Xiong, Chin-Lee Wu, Yun Miao
Low-level BK polyomavirus (BKPyV) shedding is seen in at least 10% of seropositive immunocompetent adults. Moreover, BKPyV infection is highly prevalent amongst immunocompromised populations, yet little is known on its relationship with malignancy. We studied a female patient with BKPyV-associated and donor-derived de novo high-grade sarcomatoid urothelial carcinoma developed 8 years after kidney transplantation from a male donor. Through whole-genome sequencing, we discovered integration of genotype IV BKPyV genome into the non-coding RNA (ncRNA) intronic region of human chromosome 18...
August 31, 2018: Clinical Science (1979-)
Chung Hee Baek, Hyosang Kim, Won Seok Yang, Duck Jong Han, Su-Kil Park
AIM: ABO-incompatible (ABOi) kidney transplantation (KT) has become a routine procedure with graft survival rates comparable to those of ABO-compatible KT. However, the clinical significance of the isoagglutinin titer in ABOi KT remains uncertain. Therefore, in this study, we analyzed the clinical outcomes of ABOi KT according to the baseline and postoperative isoagglutinin titer. METHODS: All patients who received ABOi KT between 2009 and 2013 were reviewed and followed up until December 2016...
June 7, 2018: Nephrology
Karel Krejci, Tomas Tichy, Jana Bednarikova, Kamil Zamboch, Josef Zadrazil
BK virus nephropathy (BKVN) is a serious opportunistic infection threatening renal function especially during the first year after transplantation. Its incidence is now on the rise and is closely related to the level of the recipient's immune system inhibition. This is more intensive with current trends in transplantation medicine, where more potent immunosuppressive protocols are used and more aggressive antirejection therapy is applied. In the absence of BK virus (BKV) specific therapy and limited treatment options for advanced BKVN, active screening of BKV replication and subsequent preemptive adjustment of immunosuppression are essential measures to prevent BKVN...
September 2018: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
Julio Pascual, Stefan P Berger, Oliver Witzke, Helio Tedesco, Shamkant Mulgaonkar, Yasir Qazi, Steven Chadban, Federico Oppenheimer, Claudia Sommerer, Rainer Oberbauer, Yoshihiko Watarai, Christophe Legendre, Franco Citterio, Mitchell Henry, Titte R Srinivas, Wen-Lin Luo, AnaMaria Marti, Peter Bernhardt, Flavio Vincenti
Background Everolimus permits reduced calcineurin inhibitor (CNI) exposure, but the efficacy and safety outcomes of this treatment after kidney transplant require confirmation. Methods In a multicenter noninferiority trial, we randomized 2037 de novo kidney transplant recipients to receive, in combination with induction therapy and corticosteroids, everolimus with reduced-exposure CNI (everolimus arm) or mycophenolic acid (MPA) with standard-exposure CNI (MPA arm). The primary end point was treated biopsy-proven acute rejection or eGFR<50 ml/min per 1...
July 2018: Journal of the American Society of Nephrology: JASN
Markus J Barten, Andreas Zuckermann
Human BK polyomavirus (BKV) infection is poorly documented in heart and lung transplant patients. BK viruria and viremia have been estimated to affect 19% and 5% of heart transplant recipients, respectively. Data are limited, especially for lung transplantation, but the proportion of patients progressing from BK viruria to viremia or BKV-related nephropathy (BKVN) appears lower than in kidney transplantation. Nevertheless, a number of cases of BKVN have been reported in heart and lung transplant patients, typically with late diagnosis and generally poor outcomes...
May 11, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
S D Hwang, J H Lee, S W Lee, K-M Park, J K Kim, M-J Kim, J H Song
BACKGROUND: Rejection and infection can occur after kidney transplantation and are important factors in preserving graft kidney function. The use of immunosuppressant agents in transplantation is therefore important, and the question of which induction therapy should be used as an immunosuppressant is controversial. OBJECTIVE: The goal of this study was to assess the comparative benefits and harms of various maintenance immunosuppressive induction agents in adults undergoing kidney transplantation by using a network meta-analysis and to generate rankings of the different immunosuppressive regimens according to their safety and efficacy...
May 2018: Transplantation Proceedings
P Skulratanasak, J Mahamongkhonsawata, M Chayakulkeereeb, N Larpparisutha, N Premasathiana, A Vongwiwatana
INTRODUCTION: BK virus-associated nephropathy (BKVAN) is a significant cause of allograft dysfunction and failure in kidney transplant recipients. Early detection and proper adjustment of immunosuppression is the best method for treatment of this condition and to improve long-term allograft outcome. Here, we reported the prevalence and risk factors of BK virus (BKV) infection in our population. METHODS: We retrospectively reviewed kidney transplant recipients at Siriraj Hospital between January 2012 and December 2015 who had been investigated using real-time polymerase chain reaction BK viral load...
May 2018: Transplantation Proceedings
Albert Z Muranda, Ludolf Greeff, Mike M Sathekge, Thabo Lengano, Victor O L Karusseit
BACKGROUND: Cryptococcosis is an important opportunistic infection of organ transplant recipients. It is the third most common fungal infection of transplant patients and occurs especially in kidney recipients. Cryptococcus neoformans is a ubiquitous fungus which infects humans by inhalation of spores. C. gattii has more recently been recognised as a pathogen. Infection commonly is disseminated affecting mainly the central nervous system and the lungs. Cryptococcoma, a localised form of the disease, has been described in various organs...
April 23, 2018: BMC Nephrology
S Querido, A Weigert, T Adragão, J Henriques, R Birne, P Matias, C Jorge, C Nascimento, M Bruges, D Machado
INTRODUCTION: HLA-sensitized patients are penalized both in the access to kidney transplantation (KT) and, once transplanted, in the incidence of rejections and long-term allograft survival despite aggressive induction and maintenance therapy. METHODS: This study retrospectively evaluates the impact of combining T- and B-cell-depleting agents and intravenous immunoglobulin for induction therapy in 45 highly sensitized KT patients (anti-panel reactive antibodies >60%, positive flow cytometry crossmatch or donor specific antibodies at the time of transplantation)...
April 2018: Transplantation Proceedings
Myriam Dao, Adrien Pécriaux, Thomas Bessede, Antoine Dürrbach, Charlotte Mussini, Catherine Guettier, Sophie Ferlicot
BK polyomavirus (BKV) nephropathy is a major concern in renal transplantation. Its main consequence is graft loss, which occurs in more than 50% of the cases. De novo renal cell carcinoma in renal allograft is a very rare event. Most of these tumors are papillary or clear cell carcinomas. We report herein the first case of collecting duct carcinoma of the renal allograft in a kidney-pancreas allograft adult recipient. Collecting duct carcinoma occurs long after the cure of a BKV nephropathy. At this time, BKV viremia and viruria were negative as well as the immunostaining for SV40 in the non-tumor kidney...
March 13, 2018: Oncotarget
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