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Objective To analyze the clinicopathological features and prognosis of polyomavirus nephropathy (PyVN) after kidney transplantation. Methods Clinical data of 44 patients who were diagnosed with PyVN after kidney transplantation were retrospectively analyzed. The causes of puncture and the time of pathological diagnosis were analyzed. Histological grading was carried out according to Banff 2018 classification. Clinical data and pathological characteristics of patients at all grades were statistically compared. BK viral DNA loads in the blood and urine were measured and renal allograft function were assessed. Clinical prognosis of all patients was compared among different groups and the risk factors affecting clinical prognosis were also analyzed. Results The time interval between pathological diagnosis of PyVN and kidney transplantation was 16(8, 29) months, and the increase of serum creatinine level was the main cause for puncture. Among 44 patients, 19 cases were classified as grade ⅠPyVN, 21 cases of grade Ⅱ PyVN and 4 cases of grade Ⅲ PyVN, respectively. Under optical microscope, there was no significant difference in the positive rate of virus inclusion bodies among different groups (P=0.148). Inflammatory cell infiltration, interstitial fibrosis and polyomavirus load in grade Ⅱ PyVN patients were all more or higher than those in grade Ⅰ counterparts. Inflammatory cell infiltration and polyomavirus load in grade Ⅲ patients were more or higher than those in grade Ⅰ counterparts. Polyomavirus load in grade Ⅲ patients was more or higher than that in grade Ⅱ counterparts. The differences were statistically significant (all P < 0.05/3). Upon diagnosis, BK viral DNA load was detected in the blood and urine of 39 patients. Among them, 38 patients were positive for BK virus in the urine and 30 patients were positive for BK virus in the blood. The serum creatinine level upon diagnosis was higher compared with that at postoperative 1 month. The serum creatinine level at the final follow-up was significantly higher than that upon diagnosis. The differences were statistically significant (P < 0.001, P=0.049). There was no significant difference in the serum creatinine level among patients with different grades of PyVN at postoperative 1 month (P=0.554). The serum creatinine level of patients with grade Ⅱ PyVN upon diagnosis was significantly higher than that of those with grade Ⅰ PyVN (P=0.007). The 1-, 3- and 5-year cumulative survival rates of renal allografts were 95%, 69% and 62%, respectively. The survival rates of renal allografts significantly differed among patients with different grades of PyVN. The higher the grade, the lower the survival rate (P=0.014). Univariate and multivariate Cox's regression analyses prompted that intrarenal polyomavirus load and serum creatinine level upon diagnosis were the independent risk factors for renal allograft dysfunction (all P < 0.05). Conclusions PyVN mainly occurs within 2 years after kidney transplantation. Clinical manifestations mainly consist of increased serum creatinine level, BK viremia and BK viruria. Postoperative routine monitoring of BK virus contributes to early diagnosis and protection of renal allografts. Banff 2018 classification may effectively predict the prognosis of renal allografts.
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Objective JC virus (JCV) infection is more common than BK virus (BKV) in general population.Systematic studies on the characteristics of JC virus nephropathy (JCVN) in renal transplant recipients are lacking.Therefore,we summarize 4 cases of JCVN in renal transplant recipients,which were diagnosed in our center in recent 10 years.Methods 165 cases of polyomavirus nephropathy (PVN) were diagnosed in our center from 2007 to 2017.Four cases of JCVN were diagnosed through the negative BKV but high JCV load in urine or blood,and positive SV40-T in the biopsy samples.Meanwhile,clinicopathological data were collected.Results At pathological diagnosis documented (87 ± 41 months after transplantation):the median levels of urinary decoy cells and JCV DNA in urine were 1/10 HPF and 5.35 × 108 copies/mL,respectively;only one patient's JC viremia was positive with 327 copies/mL.The mean level of serum creatinine (Scr) was 144 μmol/L,and the mean level of 24-h urinary protein was 0.94 g.Immunohistological staining showed SV40-T positive region of the 4 cases were all in the renal medulla.Other coexisting pathological features included IgA nephropathy in 2 patients,and suspicious chronic active antibody mediated rejection in one patients.In the latest follow-up,1 recipient got graft dysfunction while the others were in good function,the mean level of serum creatinine was 134μmol/L.Conclusion The difference between BK virus nephropathy and JCVN is that most of the JCVN are diagnosed in the late stage after kidney transplantation,the level of serum creatinine is not so high,viremia is very rare,and virus induced graft injury is not so significant.The overall prognosis of JCVN is relatively good.
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Objective To explore the clinicopathologic characteristics of polyomavirus nephropathy (PyVN) in renal transplantation.Methods Clinicopathological data from 101 cases of PyVN from January 2006 to October 2016 in our hospital were collected and analyzed retrospectively.There were 72 males and 29 females.The mean time from operation to the diagnosis of PyVN was 16.5 months (2.2-63.9 months),with 86 cases (85.1％) occurring within 2 years.The indications for biopsy included elevated serum creatinine in 81 cases (80.2％),elevated serum creatinine with proteinuria in 13 (12.9％) cases,active BK virus(BKV) infection in 5 cases (5.0％) and proteinuria in 2 cases (2.0％).Results BK viruia was detected in 98 (97.0％) recipients with viral loads of 1.5 × 109 (0-9.0 × 1011) copies/ml,and BK viremia in 80 (79.2％) recipients with viral loads of 1.8 × 104 (0-2.1 × 107) copies/ml.5 patients lost their graft function at biopsy and the other 96 patients reserved graft function with serum creatinine of 187.0 μmol/L.After 20.1 (3.7-109.6) months of follow-up,19 (18.8％) patients lost their graft function.The average serum creatinine of the 77 patients with graft function was 165.0 μmol/L,with no statistical difference (P ＞ 0.05) compared with that of patients at diagnosis.There were 18 cases of stage A,72 cases of stage B and 11 cases of stage C with 5-year allograft cumulative survival of 92.9％,82.8％ and 55.6％,respectively.Conclusions PyVN can occur within 5 years after renal transplantation,mostly within 2 years.The typical clinical manifestations include elevated serum creatinine,BK viruia and BK viremia.The severe the histopathological lesions were correlated the worse the clinical prognosis.
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BACKGROUND: Examination of urine for decoy cells (DCs) is a useful screening test for polyomavirus (PV) activation. We explored the significance of the amount of DCs in persistent shedding, PV nephropathy and acute rejection. METHODS: A case-controlled study was performed in 88 renal allograft patients who had DCs detected at least once in four or more urine samples. RESULTS: Fifty one patients were classified into the high-grade shedding group (HG) and 37 patients into the low-grade shedding group (LG) according to DC shedding (> or =10 or or =10 DCs/10 HPF is associated with sustained shedding, polymerase chain reaction positivity and PV nephropathy, but not a predictor of acute rejection.
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BACKGROUND: Examination of urine for decoy cells (DCs) is a useful screening test for polyomavirus (PV) activation. We explored the significance of the amount of DCs in persistent shedding, PV nephropathy and acute rejection. METHODS: A case-controlled study was performed in 88 renal allograft patients who had DCs detected at least once in four or more urine samples. RESULTS: Fifty one patients were classified into the high-grade shedding group (HG) and 37 patients into the low-grade shedding group (LG) according to DC shedding (> or =10 or or =10 DCs/10 HPF is associated with sustained shedding, polymerase chain reaction positivity and PV nephropathy, but not a predictor of acute rejection.
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Background: Polyomavirus nephropathy (PVN) and Cytomegalovirus (CMV) disease are the most common viral pathogens causing allograft dysfunction in renal allograft recipients. They have been observed in transplant recipients with increasing frequency in the recent years with various reports describing wide differences in the incidence of these infections in renal allografts. We present our experience with Polyomavirus (PV) infection and CMV infection in allograft of renal transplant recipients from a transplant centre in North India performing more than 100 transplants per year. Materials and Methods: 390 renal allograft specimens from 327 patients over a 4 year period, presenting with renal dysfunction were re-evaluated for presence of PVN and CMV disease utilizing histo-morphological features and immunohistochemistry. Results: Thirteen patients with PVN and four with CMV disease were identified. All patients were on triple drug immunosuppression receiving cyclosporine, prednisolone and tacrolimus or MMF. The mean period of diagnosis of viral infection after transplant was 12.4 months (seven days to 3.5 yrs) for PVN and 4.8 months (two to seven months) for CMV nephritis. Biopsies showed varying degrees of tubulointerstitial inflammation, viral inclusions and evidence of tubular damage. Associated features of acute rejection were present in 69.2% of patients with PVN. Conclusion: Histological features of PVN involving the kidneys have considerable morphological overlap with acute rejection while CMV disease presents primarily as tubulointerstitial inflammation. We observed a prevalence of 4% for PVN and 1.2% for CMV nephritis in renal allografts.