Clinical and pathological features of kidney transplant patients with concurrent polyomavirus nephropathy and rejection-associated endarteritis.

Authors:
Lisa Kim
Lisa Kim
University of Chicago Hospitals
Chicago | United States
Anthony Chang
Anthony Chang
University of Chicago
United States
Shane M Meehan
Shane M Meehan
University of Chicago
Chicago | United States

World J Transplant 2015 Dec;5(4):292-9

Stephanie M McGregor, Anthony Chang, Department of Pathology, University of Chicago Hospitals, Chicago, IL 60637, United States.

Aim: To describe the clinicopathologic features of concurrent polyomavirus nephropathy (PVN) and endarteritis due to rejection in renal allografts.

Methods: We searched our electronic records database for cases with transplant kidney biopsies demonstrating features of both PVN and acute rejection (AR). PVN was defined by the presence of typical viral cytopathic effect on routine sections and positive polyomavirus SV40 large-T antigen immunohistochemistry. AR was identified by endarteritis (v1 by Banff criteria). All cases were subjected to chart review in order to determine clinical presentation, treatment course and outcomes. Outcomes were recorded with a length of follow-up of at least one year or time to nephrectomy.

Results: Of 94 renal allograft recipients who developed PVN over an 11-year period at our institution, we identified 7 (7.4%) with viral cytopathic changes, SV40 large T antigen staining, and endarteritis in the same biopsy specimen, indicative of concurrent PVN and AR. Four arose after reduction of immunosuppression (IS) (for treatment of PVN in 3 and tuberculosis in 1), and 3 patients had no decrease of IS before developing simultaneous concurrent disease. Treatment consisted of reduced oral IS and leflunomide for PVN, and anti-rejection therapy. Three of 4 patients who developed endarteritis in the setting of reduced IS lost their grafts to rejection. All 3 patients with simultaneous PVN and endarteritis cleared viremia and were stable at 1 year of follow up. Patients with endarteritis and PVN arising in a background of reduced IS had more severe rejection and poorer outcome.

Conclusion: Concurrent PVN and endarteritis may be more frequent than is currently appreciated and may occur with or without prior reduction of IS.

Download full-text PDF

Source
http://dx.doi.org/10.5500/wjt.v5.i4.292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689940PMC

Still can't find the full text of the article?

We can help you send a request to the authors directly.
December 2015
69 Reads
2 Citations

Publication Analysis

Top Keywords

pvn endarteritis
12
pvn
10
endarteritis
8
concurrent pvn
8
viral cytopathic
8
polyomavirus nephropathy
8
concurrent polyomavirus
8
concurrent
5
patients
5
outcomes recorded
4
stable year
4
viremia stable
4
outcomes outcomes
4
endarteritis cleared
4
allograft recipients
4
course outcomes
4
therapy three
4
renal allograft
4
recorded length
4
length follow-up
4

Similar Publications