Prospective study of viral infection and nephropathy in paediatric renal transplant recipients

L. Murer, M. De Pieri, L. Barzon, M. Pacenti, M.A. Biasolo, C. Mengoli, M. Della Vella, C. Carasi, G. Montini, G. Zacchello, G. Palí¹

Author address: 

Padua, IT

Abstract: 

Objectives: Viruses with renal tropism, such as BKV and parvovirus B19, have been associated with allograft nephropathy, but the role of viral infection in acute rejection and posttransplant chronic nephopathy is controversial. Aim of the study was to prospectively investigate the prevalence of viral sequences in kidney biopsies obtained from a series of children submitted to kidney transplantation in the period 2000-2004 in a Single Centre. Virological data were correlated with clinical and histological findings. Methods: Biopsies were performed because of renal dysfunction in 8 patients or for follow-up observation at 1 year after transplantation (T1) in 53 patients. Samples were analysed for the presence of DNA of EBV, CMV, HHV6, HHV8, BKV, and parvovirus B19 by a sensitive real-time PCR technique and the results were correlated with histological analysis, performed according to the Banff 97 guidelines. Patients (26 females and 27 males, mean recipient/donor age 12.1 ± 8.3/11.9 ± 5.3 years) received immunosuppressive therapy consisting in basiliximab, steroids, cyclosporin, MMF during the first 6 months after transplantation, followed by basiliximab, steroids, and FK506 ± MMF. Mean follow-up period was 27.2 ± 6 months. Results: Viral DNA was detected in 5 out of 8 biopsies from children with allograft dysfunction, including 2 cases of BKV infection associated with tubulo-interstitial nephropathy, 3 case of parvovirus B19 infection associated with thrombotic microangiopathy, acute vascular rejection, and chronic nephropathy, respectively. Fifty out of the 53 T1 biopsies were suitable for histological and virological analyses. Viral sequences were detected in 29 out of 50 specimens (15 HHV6, 12 parvovirus B19, 3 CMV, 9 BKV, 10 EBV). No significant differences in the prevalence of viral DNA sequences and type of viral infection were observed among cases with normal histology (20/34, 58%), acute or borderline rejection (2/3, 66%), or chronic nephropathy (7/13, 53%). Kidney function at 1 and 2 years post-transplantation was not significantly different between patients with positive virological results and those with negative biopsies. Conclusions: In our series, parvovirus B19 e BKV are associated with posttransplant nephropathy and virus-associated nephropathies are the most common causes of renal dysfunction at 1-year following transplantation.
2006

abstract No: 

P687

Full conference title: 

16th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 16th (2006)