title: Effects of Parvovirus B19 Infection in Renal Transplant Recipients: A Retrospective Review of Three Cases.
abstract: Parvovirus B19 (PVB19) is a DNA virus which causes clinically relevant infection in renal transplant recipients (RTR) leading to significant morbidity. Manifestations include erythropoietin resistant anemia, proteinuria, and glomerulosclerosis in the allograft. Severe infection may require administration of intravenous immunoglobulin, reduction in immunosuppression and transfusions. The major challenge in managing and preventing the infection in RTR involves the act of balancing the decreased level of immunosuppression and the risk of rejection. The objective of this article is to understand the importance of PVB19 infection and its outcome in RTR. We reviewed the medical records of three RTR with confirmed PVB19 infection and recorded patient information including demographics, clinical and laboratory data, management, and outcome. The average time of occurrence of PVB19 infection as transplant was 8.6 weeks and they presented with symptomatic anemia. Elevated creatinine values were noted in two of them. Following treatment, anemia improved and creatinine values returned to baseline. One of them developed an early relapse and had to be treated once again similarly. We emphasize the importance of maintaining a high index of suspicion for PVB19 infection in patients with anemia in the posttransplant phase, especially in patients on higher doses of immunosuppressants. Early and proper treatment can prevent worsening clinical condition and possible effects on the allograft.
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Prathik
authors.initials: P
authors.lastname: Krishnan
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Poornima
authors.initials: P
authors.lastname: Ramadas
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Prejith P
authors.initials: PP
authors.lastname: Rajendran
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Parvathy
authors.initials: P
authors.lastname: Madhavan
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Asha
authors.initials: A
authors.lastname: Alex
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Vivek
authors.initials: V
authors.lastname: Jayaschandran
authors.affiliation: Department of Anesthesiology, Brookdale University Hospital and Medical Center, Boulevard, Manhasset, New York.
authors.forename: Shaesta G
authors.initials: SG
authors.lastname: Humayun
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ali
authors.affiliation: Department of Nephrology, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Mala
authors.initials: M
authors.lastname: Sachdeva
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Antonette
authors.initials: A
authors.lastname: Flecha
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Amit
authors.initials: A
authors.lastname: Basu
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Madhu
authors.initials: M
authors.lastname: Bhaskaran
authors.affiliation: Department of Transplant Program, North Shore University Hospital, Boulevard, Manhasset, New York.
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
keywords: allograft; anemia; immunosuppression; intravenous immunoglobulin; parvovirus B19; renal transplant