Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Studies of sequential kidney biopsies (KB) after the diagnosis of polyomavirus allograft nephropathy (PVN) are scarce and clinicopathological evolution of PVN poorly understood. In practice management is based on integration of viremia, creatinine and biopsy findings, which define multiple possible clinicopathological scenarios (CPS) (AJT 2013;1379).
The CPS at the first (1st) and second (2nd) KB were tabulated in 54 consecutive patients (pt) as follows: Viremia: A1,2,3,4 negative, decreasing, stable, increasing; creatinine (cr) B1,2,3,4 normal, decreasing, abnormal stable, increasing; SV40 KB status C1,2 positive, negative; and rejection in KB D1,2,3 negative, inconclusive, positive. Mean times for 1st and 2nd KB were 260 and 491 days, respectively.
A,B,C,D combinations lead to 160 potential CPS but only 13 and 20 actually occurred in 1st and 2nd biopsies, respectively (total 26). Five vs. 11 CPS accounted for ∼80% of possibilities in 1st and 2nd KB, respectively. In the 1st KB 90.7% had increasing viremia and PVN was presumptive in 29.6%. Definite PVN was clinical 12pt(22.2%) and subclinical (normal cr) in 26pt(48.2%). At the 2nd KB viremia was more variable and presumptive PVN occurred in 7pt(12.9%). At the 2nd KB 17pt(31.48%) had cleared the virus (15 with abnormal cr) and 6 had rejection. Persistent PVN with SV40 positivity occurred in 30pt(55.5%, 23 with abnormal cr) and 7 had rejection. Post-transplant KB time did not correlate with CPS, and ABCD variables in 1st KB did not predict values in 2nd KB. Only BK viremia correlated in both KB(p=.003) and predicted abnormal cr overall (p=.02).
A limited number of CPS was found in the 1stKB whereas a relatively larger number emerged in the 2nd KB . Analysis of larger cohorts with systematic integration of the viremia, creatinine and biopsy results (SV40 status and rejection) may increase understanding of PVN and lead to development of more rational guidelines for follow-up.
To cite this abstract in AMA style:Drachenberg C, Chaudhry M, Yang F, Ugarte R, Haririan A, Mavanur M, Cangro C, Thomas B, Costa N, Ramos E, Weir M, Papadimitriou J. Clinicopathological Scenarios (CPS) Defined by Viremia, Creatinine and Histology in Polyomavirus Nephropathy Differ in 1st and 2nd (Follow-Up) Biopsy [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/clinicopathological-scenarios-cps-defined-by-viremia-creatinine-and-histology-in-polyomavirus-nephropathy-differ-in-1st-and-2nd-follow-up-biopsy/. Accessed November 13, 2019.
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