title: Kidney retransplantation following graft loss to polyoma virus-associated nephropathy: an effective treatment option in simultaneous pancreas and kidney transplant recipients.
abstract: Polyomavirus-associated nephropathy (PVAN) has emerged as an important cause of graft loss following kidney transplantation. Experience with kidney retransplantation (reKT) in PVAN is very limited, especially in the setting of uninterrupted immunosuppression protecting the still functioning pancreatic graft after simultaneous pancreas/kidney transplantation (SPK). We present a review of five cases of reKT in four SPK recipients with Type 1 diabetes mellitus from a single centre (a second reKT was performed in one patient following first reKT failure due PVAN recurrence). Pre-emptive nephrectomy of the failed graft was performed in three of the cases and all kidney grafts for reKT were harvested from cadaveric donors. All patients are dialysis- and insulin-independent at 30 (9-55), median (range), months following last reKT with maintenance immunosuppression consisting of tacrolimus/sirolimus in three and cyclosporine A/mycophenolate mofetil in one patient. In conclusion, reKT represents an effective treatment option in SPK patients with kidney failure on account of PVAN. Use of interventions designed to reduce active viral replication, including pre-emptive nephrectomy of the failed graft, should be considered before reKT.
authors.affiliation: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Martina
authors.initials: M
authors.lastname: Mindlova
authors.forename: Petr
authors.initials: P
authors.lastname: Boucek
authors.forename: Frantisek
authors.initials: F
authors.lastname: Saudek
authors.forename: Teodora
authors.initials: T
authors.lastname: Jedinakova
authors.forename: Ludek
authors.initials: L
authors.lastname: Voska
authors.forename: Eva
authors.initials: E
authors.lastname: Honsova
authors.forename: Kvetoslav
authors.initials: K
authors.lastname: Lipar
authors.forename: Milos
authors.initials: M
authors.lastname: Adamec
authors.forename: Hans H
authors.initials: HH
authors.lastname: Hirsch
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007668:Kidney / Q000821:virology*; D007674:Kidney Diseases / Q000601:surgery / Q000821:virology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011120:Polyomavirus; D027601:Polyomavirus Infections; D012086:Reoperation; D012189:Retrospective Studies; D019737:Transplants; D014412:Tumor Virus Infections