Treatment of parvovirus B-19 (PV B-19) infection allows for successful kidney transplantation without disease recurrence.
Parvovirus B 19 (PV-B19) has emerged as a cause of glomerulopathy in native and transplanted kidneys. Disease recurrence is less well described. The clinical and pathological spectrum of PV-B19 infection can be quite variable and therefore easily missed. There are no data regarding the safety of transplantation in PV-B19-infected patients. We diagnosed a kidney transplant patient with recurrent PV-B19 infection and collapsing glomerulopathy (CG) on renal biopsy. Retrospective analysis of stored serum showed that PV-B19 DNA was present prior to the transplant. The patient was treated with intravenous immunoglobulin (IVIG), and eventually the virus was successfully eradicated after allograft loss and discontinuation of immunosuppressive medications. The patient subsequently received her fourth kidney transplant. Polymerase chain reaction (PCR) for PV-B19 DNA was negative on multiple occasions for approximately 1 year prior to her transplant. The patient is now 22 months post transplantation, quarterly serum PCRs continue to be negative for PV-B19 DNA despite reinstitution of immunosuppressive therapy. The patient's renal function remains stable with a serum creatinine of 0.9 mg/dL and a serum albumin of 4.2 g/dL. Successful diagnosis and treatment of PV-B19 viremia appears to allow for successful transplantation without evidence of disease recurrence. Since PV-B19 can cause significant morbidity post transplant, it is important to screen potential transplant candidates at risk for PV-B19 infection pre transplant. Careful surveillance post transplantation is necessary to identify disease recurrence so that early treatment can be initiated.
Cedars-Sinai Medical Center, UCLA School of Medicine, L.A., CA 90048, USA.
Noha R
NR
Barsoum
Suphamai
S
Bunnapradist
Asha
A
Mougdil
Mieko
M
Toyoda
Ashley
A
Vo
Stanley C
SC
Jordan
D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D003401:Creatine / Q000097:blood; D005260:Female; D015774:Ganciclovir / Q000494:pharmacology / Q000627:therapeutic use; D006084:Graft Rejection / Q000209:etiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D016030:Kidney Transplantation; D008875:Middle Aged; D010322:Parvoviridae Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016732:Parvovirus B19, Human; D012008:Recurrence; D014184:Transplantation, Homologous
D000998:Antiviral Agents; D006454:Hemoglobins; D016756:Immunoglobulins, Intravenous; D003401:Creatine; D015774:Ganciclovir