Parvovirus B19 Infection as a Cause of Refractory Anemia in Kidney Transplant Recipients: A Case Series

Kidney transplant recipients (KTRs) are at higher risk for infections, including parvovirus B19 (PVB19). This virus typically presents within the first-year posttransplant, causing anemia and potentially leading to increased morbidity and graft dysfunction.

Charts of patients undergoing kidney transplantation between May 2013 and March 2022 were reviewed. Twenty-one patients had PVB19. Their clinical presentation, laboratory parameters, and outcomes were studied. The diagnosis of PVB19 was established by PVB19 DNA Polymerase Chain Reaction (PCR) and bone marrow examination (BME).

Prevalence of PVB19 disease was 1.9% (21/1164) with a median onset time of 39 days posttransplantation. The most frequent clinical symptoms were fatigue reported by 76% of patients, followed by fever (47%), dyspnea (23%), and myalgia (33%). All patients (100%) developed anemia, while leukopenia and thrombocytopenia were observed in 14% and 9.5% of patients, respectively. Graft dysfunction was observed in 61.9% (13/21) patients. Diagnosis was confirmed by PCR in 20 out of 21 patients. One patient had a typical viral inclusion on BME. Immunosuppression, especially antiproliferative, was reduced in all patients. Eight patients received intravenous immunoglobulin, eight received packed cell blood transfusion, and seven received erythropoietin therapy. All patients recovered, with a median time of 30 days for hemoglobin levels to normalize. One patient had graft loss secondary to graft rejection.

PVB19, while uncommon, can be a significant cause of refractory anemia, particularly within the first-year posttransplant. Diagnosing PVB19 infection with PCR is crucial, and the primary treatment involves reducing immunosuppressants, especially antiproliferative agents.