Treatment and Outcomes of Simultaneous Acute Rejection and Polyomavirus Allograft Nephropathy.
University of Maryland, Baltimore, MD
Meeting: 2017 American Transplant Congress
Abstract number: A224
Keywords: Kidney transplantation, Polyma virus, Rejection
Session Information
Session Name: Poster Session A: Kidney: Polyoma
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Background: Reduction of immunosuppression for polyomavirus allograft nephropathy (PVAN) is associated with risk of acute rejection (AR), and in uncommon cases both are present together at diagnosis. Treatment of AR in the setting of PVAN is challenging, and there is limited data in this regard. We sought to examine treatment and graft outcomes after concurrent pathology.
Methods: Renal transplant recipients between 2010-2016 with biopsy-proven PVAN+AR were included.
Results: In the study period, 18 cases of simultaneous PVAN+AR were identified. Select characteristics and treatment details are outlined in the table. All patients received lymphocyte-depleting induction therapy. Simultaneous PVAN+AR was preceded by PVAN alone in 8 patients (44%), and by AR alone in 2 patients (11%). For PVAN+ACR, the rejection grade was 1B or greater in 8 (67%) of patients. After AR treatment, all patients had maintenance IS changes, the most common being reduction of CNI goal (61%). Graft failure occurred in 6 (33%), all of which occurred as sequela of the concurrent pathology; 2 patients have undergone re-transplant.
| Characteristic | n=18 |
| Age at Transplant (years), mean±SD | 52±10 |
| Male, n (%) | 15 (83) |
| Ethnicity, n (%)
African American Caucasian Other |
9 (50)
6 (33) 3 (17) |
| Transplant Type, n (%)
LD DD |
10 (56)
8 (44) |
| Time from Transplant to PVAN+AR in Days, median (range) | 120 (73-974) |
| Tacrolimus Level at Biopsy, mean±SD | 5.1±2.9 |
| Rejection Type, n (%)
ACR AMR Mixed |
12 (67)
4 (22) 2 (11) |
| Initial Rejection Treatment, n (%)
Steroids+IVIg Steroids rATG IVIg Steroids+PP+IVIg |
7 (39)
6 (33) 2 (11) 2 (11) 1 (6) |
| Maintenance IS Changes Post-Biopsy, n (%)
Reduction in tacrolimus/belatacept dose Reduction in MMF dose Reduction in steroid dose |
11 (61)
6 (33) 1 (6) |
| Ongoing BPAR after Initial Treatment, n (%) | 11 (61) |
| Graft Loss | 6 (33) |
| Time to Graft Loss from Initial Biopsy in Days, median (range) | 389 (113-786) |
| Mortality, n (%) | 2 (11) |
Conclusions: These data reinforce the precarious balance between rejection and infection in the renal transplant population. Almost 50% of the patients with PVAN+AR experienced PVAN alone prior to the development of simultaneous pathology, which may be attributed to aggressive IS minimization upon presentation of PVAN. Simultaneous pathology can result in rapid graft loss; therefore this population warrants close follow-up.
CITATION INFORMATION: Sparkes T, Hammad S, Drachenberg C, Haririan A. Treatment and Outcomes of Simultaneous Acute Rejection and Polyomavirus Allograft Nephropathy. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Sparkes T, Hammad S, Drachenberg C, Haririan A. Treatment and Outcomes of Simultaneous Acute Rejection and Polyomavirus Allograft Nephropathy. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/treatment-and-outcomes-of-simultaneous-acute-rejection-and-polyomavirus-allograft-nephropathy/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress