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Pathology of resolving polyomavirus-associated nephropathy.

T Menter¹, M Mayr, S Schaub

¹Institute for Pathology, University Hospital Basel, Basel, Switzerland.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons

|June 1, 2013

Summary

Reducing immunosuppression effectively controls polyomavirus BK (BKV) and resolves BKV-associated nephropathy (PyVAN). Resolving PyVAN shows inflammation similar to interstitial rejection but typically self-limits, preserving allograft function.

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Area of Science:

Nephrology
Virology
Immunology

Background:

Polyomavirus BK (BKV) infection is a significant complication after kidney transplantation.
BKV-associated nephropathy (PyVAN) management often involves reducing immunosuppression.
The histological changes during PyVAN resolution are not well-characterized.

Purpose of the Study:

To systematically investigate the morphology of resolving BKV-associated nephropathy (PyVAN).
To correlate histological findings with BKV viremia levels and clinical outcomes.
To assess the impact of immunosuppression reduction on PyVAN resolution and allograft function.

Main Methods:

Analysis of 99 surveillance biopsies from 35 kidney transplant patients with BKV viremia.
Biopsies were scored using Banff criteria and grouped by BKV viremia status (pre-, increasing, decreasing, post-).
Correlation of SV40 immunohistochemistry with plasma BKV load and assessment of inflammatory markers.

Main Results:

97% of patients cleared BKV viremia after a median of 9 months.
Tubulitis and interstitial inflammation scores increased during decreasing viremia and persisted post-clearance.
Resolving PyVAN showed features of acute interstitial nephritis, sometimes with plasma cell infiltration and HLA-DR expression.

Conclusions:

Reducing immunosuppression is effective in clearing BKV viremia and resolving PyVAN.
Resolving PyVAN exhibits histological characteristics that can mimic interstitial rejection.
The process is typically self-limiting, with stable or improved allograft function and low rates of clinical rejection post-clearance.