Polyomavirus disease under new immunosuppressive drugs: a cause of renal graft dysfunction and graft loss

Publication

Polyomavirus disease under new immunosuppressive drugs: a cause of renal graft dysfunction and graft loss

Journal Paper/Review - Mar 27, 1999

Binet Françoise-Isabelle, Nickeleit V, Hirsch H H, Prince O, Dalquen P, Gudat F, Mihatsch M J, Thiel G

Units

Nephrologie | Transplantationsmedizin

PubMed

10199744

Citation

Binet F, Nickeleit V, Hirsch H, Prince O, Dalquen P, Gudat F, Mihatsch M, Thiel G. Polyomavirus disease under new immunosuppressive drugs: a cause of renal graft dysfunction and graft loss. Transplantation 1999; 67:918-22.

Type

Journal Paper/Review (English)

Journal

Transplantation 1999; 67

Publication Date

Mar 27, 1999

Issn Print

0041-1337

Pages

918-22

Brief description/objective

BACKGROUND: Manifest polyomavirus (PV) renal graft infection is a rare complication. We diagnosed 5 cases among 70 kidney recipients undergoing transplants since December 1995; however, there were no cases at our institution before December 1995. METHOD: To identify risk factors promoting manifest PV graft infection, we compared those 5 patients with kidney recipients who had signs of PV replication but no manifest graft infection (n=23, control group). PV replication was judged by the presence of intranuclear inclusion cells in the urine. RESULTS: Before the infection, five of five patients had recurrent rejection episodes. All were switched from cyclosporine A to high dose tacrolimus as rescue therapy. Infection was diagnosed histologically 9+/-2 months posttransplantation; it persisted and led to graft loss in four of five patients. In control patients, graft function was stable, 1 of 23 patients were switched to tacrolimus as rescue therapy, and graft loss occurred in 4 of 23 patients. CONCLUSION: Recurrent rejection episodes and high dose immunosuppressive therapy, including tacrolimus, are risk factors for manifest PV kidney graft infection, which has an ominous prognosis.