Clinical and pathological features of kidney transplant patients with concurrent polyomavirus nephropathy and rejection-associated endarteritis
Clinical and pathological features of kidney transplant patients with concurrent polyomavirus nephropathy and rejection-associated endarteritis作者机构：Department of PathologyUniversity of Chicago Hospitals Department of MedicineSection of NephrologyUniversity of Chicago Hospitals Hawaii Pathologists’ Laboratory Sharp Memorial Hospital
出 版 物：《World Journal of Transplantation》 (世界移植杂志)
年 卷 期：2015年第5卷第4期
页 面：292-299页
学科分类：10[医学]
主 题：Acute rejection BK polyomavirus Kidney transplant Polyomavirus nephropathy
摘 要：AIM: To describe the clinicopathologic features of concurrent polyomavirus nephropathy(PVN) and endarteritis due to rejection in renal ***: We searched our electronic records database for cases with transplant kidney biopsies demonstrating features of both PVN and acute rejection(AR). PVN was defined by the presence of typical viral cytopathic effect on routine sections and positive polyomavirus SV40 large-T antigen immunohistochemistry. AR was identified by endarteritis(v1 by Banff criteria). All cases were subjected to chart review in order to determine clinical presentation, treatment course and outcomes. Outcomes were recorded with a length of follow-up of at least one year or time to nephrectomy. RESULTS: Of 94 renal allograft recipients who developed PVN over an 11-year period at our institution, we identified 7(7.4%) with viral cytopathic changes, SV40 large T antigen staining, and endarteritis in the same biopsy specimen, indicative of concurrent PVN and AR. Four arose after reduction of immunosuppression(IS)(for treatment of PVN in 3 and tuberculosis in 1), and 3 patients had no decrease of IS before developing simultaneous concurrent disease. Treatment consisted of reduced oral IS and leflunomide for PVN, and antirejection therapy. Three of 4 patients who developed endarteritis in the setting of reduced IS lost their grafts to rejection. All 3 patients with simultaneous PVN and endarteritis cleared viremia and were stable at 1 year of follow up. Patients with endarteritis and PVN arising in a background of reduced IS had more severe rejection and poorer ***: Concurrent PVN and endarteritis may be more frequent than is currently appreciated and may occur with or without prior reduction of IS.
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