BK virus nephropathy after simultaneous pancreas-kidney transplantation

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: BK virus nephropathy (BKVN) was reported in up to 7.5% of patients after simultaneous pancreas-kidney transplantation (SPK). Its management by reduction in immunosuppression might pre-dispose to pancreatic graft loss.Methods: A retrospective analysis of 178 SPK recipients was performed. All patients received thymoglobulin, daclizumab and a maintenance of low-dose steroids, tacrolimus, and either sirolimus or mycophenolate.Results: Two (1.1%) patients were identified with BKVN. Time of diagnosis was 22 and 45 months after transplant. Both patients had superimposed calcineurin toxicity in their graft biopsies. Immunosuppression was reduced in both patients, and leflunomide (LEF) was used in one patient. Concurrent kidney rejection episodes were treated with steroid pulses in both patients. One kidney graft improved with a last estimated glomerular filtration rate (GFR) of 43 mL/min, and another kidney graft showed limited improvement with a last GFR of 30 mL/min. Pancreatic graft function remained excellent in both patients as assessed by serum c-peptide, glycosylated hemoglobin, amylase-lipase, and urine amylase levels.Conclusion: Low incidence of BKVN was observed in our SPK series. Reduction in immunosuppression and sometimes LEF can be effective. The underlying mechanism of stable pancreatic allograft function despite ongoing kidney rejection warrants further investigation.

Original languageEnglish
Pages (from-to)801-806
Number of pages6
JournalClinical Transplantation
Volume24
Issue number6
DOIs
StatePublished - Nov 1 2010

Fingerprint

BK Virus
Pancreas Transplantation
Kidney Transplantation
leflunomide
Transplants
Immunosuppression
Kidney
Amylases
Glomerular Filtration Rate
Steroids
Calcineurin
Glycosylated Hemoglobin A
Tacrolimus
Sirolimus
Lipase
Allografts
Maintenance
Urine
Biopsy
Peptides

Keywords

  • Immunosuppression
  • Kidney/pancreas transplantation
  • Leflunomide
  • Polyomavirus
  • Type 1 diabetes
  • Viral infection

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{244f5f86dcd04a92816dc4a0d7a5f535,
title = "BK virus nephropathy after simultaneous pancreas-kidney transplantation",
abstract = "Background: BK virus nephropathy (BKVN) was reported in up to 7.5{\%} of patients after simultaneous pancreas-kidney transplantation (SPK). Its management by reduction in immunosuppression might pre-dispose to pancreatic graft loss.Methods: A retrospective analysis of 178 SPK recipients was performed. All patients received thymoglobulin, daclizumab and a maintenance of low-dose steroids, tacrolimus, and either sirolimus or mycophenolate.Results: Two (1.1{\%}) patients were identified with BKVN. Time of diagnosis was 22 and 45 months after transplant. Both patients had superimposed calcineurin toxicity in their graft biopsies. Immunosuppression was reduced in both patients, and leflunomide (LEF) was used in one patient. Concurrent kidney rejection episodes were treated with steroid pulses in both patients. One kidney graft improved with a last estimated glomerular filtration rate (GFR) of 43 mL/min, and another kidney graft showed limited improvement with a last GFR of 30 mL/min. Pancreatic graft function remained excellent in both patients as assessed by serum c-peptide, glycosylated hemoglobin, amylase-lipase, and urine amylase levels.Conclusion: Low incidence of BKVN was observed in our SPK series. Reduction in immunosuppression and sometimes LEF can be effective. The underlying mechanism of stable pancreatic allograft function despite ongoing kidney rejection warrants further investigation.",
keywords = "Immunosuppression, Kidney/pancreas transplantation, Leflunomide, Polyomavirus, Type 1 diabetes, Viral infection",
author = "Edip Akpinar and Gaetano Ciancio and Jun Sageshima and Chen, {Linda J} and Giselle Guerra and Warren Kupin and David Roth and Phillip Ruiz and Burke, {George W}",
year = "2010",
month = "11",
day = "1",
doi = "10.1111/j.1399-0012.2009.01204.x",
language = "English",
volume = "24",
pages = "801--806",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - BK virus nephropathy after simultaneous pancreas-kidney transplantation

AU - Akpinar, Edip

AU - Ciancio, Gaetano

AU - Sageshima, Jun

AU - Chen, Linda J

AU - Guerra, Giselle

AU - Kupin, Warren

AU - Roth, David

AU - Ruiz, Phillip

AU - Burke, George W

PY - 2010/11/1

Y1 - 2010/11/1

N2 - Background: BK virus nephropathy (BKVN) was reported in up to 7.5% of patients after simultaneous pancreas-kidney transplantation (SPK). Its management by reduction in immunosuppression might pre-dispose to pancreatic graft loss.Methods: A retrospective analysis of 178 SPK recipients was performed. All patients received thymoglobulin, daclizumab and a maintenance of low-dose steroids, tacrolimus, and either sirolimus or mycophenolate.Results: Two (1.1%) patients were identified with BKVN. Time of diagnosis was 22 and 45 months after transplant. Both patients had superimposed calcineurin toxicity in their graft biopsies. Immunosuppression was reduced in both patients, and leflunomide (LEF) was used in one patient. Concurrent kidney rejection episodes were treated with steroid pulses in both patients. One kidney graft improved with a last estimated glomerular filtration rate (GFR) of 43 mL/min, and another kidney graft showed limited improvement with a last GFR of 30 mL/min. Pancreatic graft function remained excellent in both patients as assessed by serum c-peptide, glycosylated hemoglobin, amylase-lipase, and urine amylase levels.Conclusion: Low incidence of BKVN was observed in our SPK series. Reduction in immunosuppression and sometimes LEF can be effective. The underlying mechanism of stable pancreatic allograft function despite ongoing kidney rejection warrants further investigation.

AB - Background: BK virus nephropathy (BKVN) was reported in up to 7.5% of patients after simultaneous pancreas-kidney transplantation (SPK). Its management by reduction in immunosuppression might pre-dispose to pancreatic graft loss.Methods: A retrospective analysis of 178 SPK recipients was performed. All patients received thymoglobulin, daclizumab and a maintenance of low-dose steroids, tacrolimus, and either sirolimus or mycophenolate.Results: Two (1.1%) patients were identified with BKVN. Time of diagnosis was 22 and 45 months after transplant. Both patients had superimposed calcineurin toxicity in their graft biopsies. Immunosuppression was reduced in both patients, and leflunomide (LEF) was used in one patient. Concurrent kidney rejection episodes were treated with steroid pulses in both patients. One kidney graft improved with a last estimated glomerular filtration rate (GFR) of 43 mL/min, and another kidney graft showed limited improvement with a last GFR of 30 mL/min. Pancreatic graft function remained excellent in both patients as assessed by serum c-peptide, glycosylated hemoglobin, amylase-lipase, and urine amylase levels.Conclusion: Low incidence of BKVN was observed in our SPK series. Reduction in immunosuppression and sometimes LEF can be effective. The underlying mechanism of stable pancreatic allograft function despite ongoing kidney rejection warrants further investigation.

KW - Immunosuppression

KW - Kidney/pancreas transplantation

KW - Leflunomide

KW - Polyomavirus

KW - Type 1 diabetes

KW - Viral infection

UR - http://www.scopus.com/inward/record.url?scp=78649844315&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649844315&partnerID=8YFLogxK

U2 - 10.1111/j.1399-0012.2009.01204.x

DO - 10.1111/j.1399-0012.2009.01204.x

M3 - Article

VL - 24

SP - 801

EP - 806

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 6

ER -