title: Polyomavirus in kidney and kidney-pancreas transplant recipients.
abstract: OBJECTIVE
  To report the incidence and clinical characteristics of polyomavirus (PV) nephritis in kidney (KTX) and kidney-pancreas transplant (KPTX) recipients.
  
  
  METHODS
  Single center retrospective analysis of all cases of PV nephritis in KTX and KPTX patients transplanted between 1994 and 1999.
  
  
  RESULTS
  Thirteen (5 KTX and 8 KPTX) patients (2.1%) had PV nephritis diagnosed on multiple biopsies (n = 22) among 504 KTX and 106 KPTX recipients. The incidence of PV nephritis was higher in cadaver donor transplants (2.6% cadaver vs. 0.7% living donors), after KPTX (1% KTX vs. 7.5% KPTX), in males (3.3% male vs. 0.7% female), and in diabetic patients (4.4% diabetic vs. 0.8% nondiabetic). The mean time to diagnosis of PV nephritis was 18 (range 6-48) months after KTX and 17 (range 9-31) months after KPTX. Three KTX patients and 5 KPTX patients had calcineurin inhibitor toxicity on biopsy prior to developing PV nephritis. Reduction in immunosuppression occurred in 100% of KTX and 63% of KPTX patients. Three patients (23%) developed rejection within 3 months of diagnosis of PV, 1 after a reduction in immunosuppression. Despite multiple antiviral treatment regimens, renal allograft failure requiring dialysis occurred in 60% of KTX and 50% of KPTX patients. All KPTX patients remain insulin independent and 2 were successfully retransplanted with living donor kidneys. 2 patients (15%) died but there was no mortality directly related to the virus.
  
  
  CONCLUSIONS
  Polyomavirus nephritis may be increasing in incidence and appears to be unresponsive to either conventional antiviral agents or a reduction in immunosuppression. Most of our cases occurred in male diabetic patients undergoing cadaveric donor transplantation and were preceded by biopsy-proven nephrotoxicity. Further studies are needed to better define the pathogenesis of PV and effective antiviral treatment.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, USA.
authors.forename: J
authors.initials: J
authors.lastname: Trofe
authors.forename: L W
authors.initials: LW
authors.lastname: Gaber
authors.forename: R J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: M H
authors.initials: MH
authors.lastname: Shokouh-Amiri
authors.forename: S R
authors.initials: SR
authors.lastname: Vera
authors.forename: R R
authors.initials: RR
authors.lastname: Alloway
authors.forename: A
authors.initials: A
authors.lastname: Lo
authors.forename: A O
authors.initials: AO
authors.lastname: Gaber
authors.forename: M F
authors.initials: MF
authors.lastname: Egidi
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D007668:Kidney / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009393:Nephritis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D010179:Pancreas / Q000473:pathology / Q000821:virology; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011120:Polyomavirus / Q000302:isolation & purification; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome