The leading cause of pediatric kidney transplant loss is chronic renal allograft dysfunction (CRAD). Currently, the etiology of CRAD is thought to be multi-factorial. While symptomatic Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infection have been associated with CRAD, the contribution of subclinical viremia is unclear. We sought to determine whether subclinical EBV and CMV viremia are associated with the presence of biopsy-proven interstitial fibrosis and tubular atrophy (IF/TA), one of the hallmarks of CRAD.
We analyzed 74 pediatric patients (1 to 19 yo) who received a kidney transplant from January 1, 2005 to December 31, 2011. Subclinical viremia was defined as the presence of greater than 10 copies/PCR of EBV or greater than 500 copies/mL of CMV by PCR in patients with no clinical symptoms. Biopsies were obtained as per protocol at 6 and 12 months post-transplant or for cause. We analyzed biopsies for IF/TA or acute rejection using Banff 2009 criteria. We correlated patients' viremia status with biopsy results, incidence of acute rejection and presence of donor specific antibodies (DSAs) using Fisher's Exact Test.
At 3 months post-transplant, 11 of the 74 patients developed subclinical viremia, of which 36% (4/11) had IF/TA on a six month biopsy, while only 3% (2/63) of patients without subclinical viremia at 3 months had IF/TA present at that biopsy (p = 0.004). At 6 months post-transplant, 14 patients had developed subclinical viremia and 64% (9/14) had IF/TA present on the 1 year protocol biopsy, whereas only 15% (9/60) of patients without viremia at 6 months had IF/TA present at 1 year (p < 0.001). There were no significant relationships between subclinical viremia and acute rejection or presence of DSAs to account for the IF/TA.
We conclude that in pediatric kidney transplant patients, subclinical viremia is significantly associated with the presence of IF/TA on kidney biopsy early in transplantation. Moreover, the length of time with subclinical viremia appears to play an important role in the development of IF/TA.
To cite this abstract in AMA style:Avasare S, Ettenger R, Gjertson D, Puliyanda D, Tsai E. Subclinical EBV and CMV Viremia Is Significantly Associated with the Development of Interstitial Fibrosis and Tubular Atrophy (IF/TA) in Pediatric Renal Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/subclinical-ebv-and-cmv-viremia-is-significantly-associated-with-the-development-of-interstitial-fibrosis-and-tubular-atrophy-ifta-in-pediatric-renal-transplant-recipients/. Accessed May 17, 2021.
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