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Related Experiment Videos

Post-transplantation polyomavirus infections.

S Boubenider1, C Hiesse, S Marchand

  • 1Service de Néphrologie, Centre Hospitalier Universitaire de Bicêtre, Université Paris XI, France.

Journal of Nephrology
|April 15, 1999
PubMed
Summary
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Daclizumab Versus Rabbit Antithymocyte Globulin in High-Risk Renal Transplants: Five-Year Follow-up of a Randomized Study.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons·2015

BK and JC viruses (BKV and JCV) are common human polyomaviruses that can reactivate in transplant patients, causing nephritis that mimics rejection. Early detection is crucial to avoid incorrect treatment and potential graft loss.

Area of Science:

  • Nephrology
  • Virology
  • Transplantation Immunology

Background:

  • BK virus (BKV) and JC virus (JCV), known as human polyomaviruses (HPVs), infect over 60% of the global population and persist asymptomatically in the kidneys.
  • Reactivation of HPVs, particularly BKV and JCV, is a significant concern in immunocompromised individuals, especially following renal transplantation and bone marrow transplantation (BMT).
  • HPVs are increasingly recognized as a cause of interstitial nephritis in transplant recipients, often presenting with histological features indistinguishable from acute rejection or drug toxicity.

Purpose of the Study:

  • To highlight the clinical significance of BK and JC viruses in kidney transplant recipients.
  • To discuss the diagnostic challenges and potential consequences of misdiagnosing HPV-associated nephritis.
  • To emphasize the need for improved screening and management strategies for HPV infections post-transplantation.

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Main Methods:

  • Histopathological examination of renal biopsies showing interstitial inflammation, tubular injury, and characteristic viral inclusions.
  • Detection of HPV DNA using techniques such as DNA hybridization or polymerase chain reaction (PCR).
  • Review of clinical data and outcomes in transplant recipients with confirmed HPV infections.

Main Results:

  • BKV and JCV reactivation occurred in 22.2% and 10.9% of renal transplant recipients, respectively.
  • In BMT patients, reactivation rates were higher, with 55% for BKV and 6.7% for JCV.
  • HPV nephritis can mimic acute rejection (meeting Banff criteria) or drug toxicity, leading to diagnostic confusion.

Conclusions:

  • Distinguishing HPV nephritis from rejection or drug toxicity is critical to guide appropriate immunosuppression management.
  • Misdiagnosis can lead to over-immunosuppression, increasing viral load and graft damage, or to unnecessary reduction of immunosuppression, risking graft loss.
  • The lack of routine screening for HPVs likely leads to underestimation of their prevalence and impact in transplant populations; specific therapies are currently unavailable.