Session Name: Kidney: Polyoma
Session Date & Time: None. Available on demand.
*Purpose: Patients with non-renal organ transplantation (TX) may suffer BK-viral nephropathy (BKVN) of their own orthotopic kidneys. We aimed to know if these patients with BKVN after non-renal organ transplantation differ from renal transplant (TX) patients with BKVN.
*Methods: We followed retrospectively the clinical course of non-renal transplant patients with BKVN.
*Results: Since 2001, we have seen twelve patients with biopsy-proven and one with clinically highly suggestive BKVN after non-renal organ transplantation (eight patients after lung, and two after heart TX, respectively; two after hematopoetic stem cell transplantation (HSCT); and one other patient without being transplanted at all but with biopsy-proven BKVN and interstitial renal infiltration of chronic lymphatic leucemia cells). All ten patients with lung and heart TX had calcineurin-based triple or dual immnosuppression. Four patients with chronic lung TX and both patients with HSCT and graft versus host reaction needed additional immunosuppression. Twelve of thirteen patients were men (92%); age at TX (n=12) was 39±18 yrs (5-69). Six of thirteen patients had end stage renal disease (ESRD, 46%), and the other seven had progressive renal insufficiency with eGFR <25mL/min (54%); five patients died (38%). Diagnosis by renal biopsy was established 87±107 months after TX in 12/13 patients. Maximum of viruria was 76,5±41,1 million copies/mL in 10/13 patients (3 not tested); and maximum of viremia 4,1±6,9 million copies/mL in 12/13 patients (1 not tested since no TX). First positivity of viruria and viremia PCR was measured 75±77 and 39±43 months in 9 and 12 patients, respectively, after TX.
*Conclusions: In patients after non-renal Tx, BKVN of the orthotopic kidneys develops always by reactivation of their own viral population living in latency of urothelial cells. BKVN after non-renal TX occurs preferentially after lung, but also after heart TX and HSCT. Diagnosis is established late and with high viral load of long persistence. The patients develop severe renal insufficiency and often ESRD, five patients died. The course of BKVN of orthotopic kidneys after non-renal transplantation seems to be more malignant than BKVN after renal transplantation.
To cite this abstract in AMA style:Schwarz A, Schmitz J, Braesen J, Bara C, Sauer M, Haller H, Gottlieb J. Polyomavirus BK-Associated Nephropathy in Patients After Renal and Extrarenal Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/polyomavirus-bk-associated-nephropathy-in-patients-after-renal-and-extrarenal-transplantation/. Accessed June 11, 2021.
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