Treatment strategies and outcome of parvovirus b19 infection in kidney transplant recipients: a case series and literature review of 128 patients.

Abstract Background There is no specific antiviral treatment for parvovirus B19 (PVB19) infection. Objective The objective of this study was to study the treatment and outcome of PVB19 infection in kidney transplant recipients (KTR) at our institution, and cases published in the medical literature. Methods We conducted a retrospective review of PVB19 infection in KTR at an academic medical center over a 16-year period and summarized the data on its treatment and outcome in 120 KTR in the medical literature. Results In our cohort of eight patients, the median time to the onset of PVB19 disease was 7.2 weeks after transplantation. All patients had severe aregenerative anemia (mean hemoglobin (Hb) of 6.2 ± 1.0 g/dl); all were treated with a reduction in their immunosuppressive regimen and the administration of single-dose intravenous immunoglobulin (IVIG) (mean total dosage of 0.87 ± 0.38 g/kg). The median time to anemia improvement (Hb >10 g/dl) was 3-week post-treatment. No recurrences were documented during follow-up (median 25 months). Among 128 patients (including our cohort of 8 and 120 reported in literature), therapeutic strategies included: 43% IVIG alone, 39% IVIG and reduced immunosuppression, 9% reduction of immunosuppression, and 9% conservative therapy. Clinical relapses were observed in 35% of 71 reported cases. Conclusions In KTR, decreasing immunosuppression and the administration of low-dose immunoglobulin seem to be not worse than the standard dose in PVB19 infection.

Infecciones en pacientes sometidos a trasplante de órgano sólido / Infections in solid organ transplant recipients

The main problems in solid organ transplant recipients are rejection and infections. The new immunosuppressive regimens have lowered the risk of rejection, however, infections continue to be one of the most important determinants for morbidity and mortality in these patients. The survival of the transplanted organ is also impacted by the different infectious diseases that occur in the post-transplant period. These infections are of viral, bacterial, fungal and parasitic origin, and their presentation occurs characteristically within well defined risk periods after the transplant. The clinical presentation is commonly atypical; therefore for optimal management, it is necessary to have a through knowledge of the epidemiology and clinical manifestations of these problems, but most importantly, the experience of the clinician in the clinical approach and early detection will result in better outcomes. We review recent information regarding the infectious diseases that affect solid organ recipients according to the type of transplant, the post-transplant, risk factors before the transplant and the type of immunosuppressive therapy used, which are the main determinants for these complications and their prognosis.

Los problemas principales en el paciente sometido a trasplante de órgano sólido (TOS) son el rechazo del órgano y las infecciones. Los nuevos esquemas inmunosupresores han disminuido el riesgo de rechazo, sin embargo, las infecciones siguen siendo uno de los determinantes más importantes de morbilidad y mortalidad en estos pacientes. La sobrevida del órgano trasplantado es impactada también por los diversos procesos infecciosos que ocurren en el periodo postrasplante. Las infecciones que afectan a estos pacientes son de origen viral, bacteriano, fúngico y parasitario y su presentación ocurre característicamente dentro de periodos bien definidos de riesgo posterior al trasplante. La presentación clínica frecuentemente es atípica, por lo que para el manejo óptimo es necesario conocer la epidemiología y las manifestaciones clínicas de estos problemas, pero sobre todo la experiencia del clínico en el abordaje y en la detección temprana resulta en un mejor desenlace. En este artículo se revisa la información reciente sobre las enfermedades infecciosas que afectan a pacientes sometidos a TOS de acuerdo con el tipo de trasplante, al periodo postrasplante, a los factores de riesgo previo al trasplante y al tipo de terapia inmunosupresora utilizada, los cuales son los principales determinantes de estas complicaciones y de su pronóstico.