Renal transplantation: complications: infectionsPolyomavirus BK infection
Section snippets
Patients and methods
From the 89 renal or pancreas/kidney allograft recipients in our center in 2001 and 2002, we collected blood samples at the end of 1, 3, 6, and 12 months. All specimens were tested with the PCR technique for BKV DNA. In cases of increased creatinine levels, a renal allograft biopsy was performed. In addition to routine histopathological examination, biopsy specimens were stained for the T antigen SV 40, which shows a 98% protein homology with BKV.
Results
BKV DNA was detected in 1 or more serum samples of 17 patients at a mean of 27 weeks after transplantation (range, 4–25 weeks). A biopsy was performed at least once in 45 patients in the study group, 10 of whom were BKV DNA–positive. BK nephropathy was diagnosed in only 1 case.
Acute interstitial rejection (IA or IB according to Banff 1997) was observed in 4 (40%) of 10 PCR-positive patients versus 4 (11%) of 35 in the PCR-negative group. Acute vascular rejection (IIA according to Banff 1997)
Discussion
The vast majority of BK nephropathy was observed in renal allografts but not in native kidneys, implying that there is a specific risk factor for graft recipients. Among others, ischemia and immunosuppressive drugs have been suggested. In our study, treatment with MMF and ischemia time were not risk factors for BKV replication. We did observe an increased incidence of CMV infection in patients with signs of BKV replication, but this may be attributed to the general susceptibility of those
Conclusions
The results suggest that graft function in patients with signs of BKV replication (but without BK nephropathy) was the same as in patients with no viral replication. Acute rejection may contribute to viral replication. There were positive correlations between serum BKV replication and histopathological findings of plasma cell infiltrates and plasmacytic tubulitis, features that may be helpful to select patients likely to experience BK nephropathy. In our opinion, these patients require close
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