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Tissue viral DNA is associated with chronic allograft nephropathy
Author(s) -
Šebeková Katarína,
Feber Janusz,
Carpenter Blair,
Shaw Laura,
Karnauchow Tim,
DiazMitoma Francisco,
Filler Guido
Publication year - 2005
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2005.00347.x
Subject(s) - medicine , valganciclovir , renal function , kidney , gastroenterology , nephropathy , biopsy , immunosuppression , kidney transplantation , tacrolimus , chronic allograft nephropathy , urology , transplantation , creatinine , bk virus , pathology , ganciclovir , immunology , virus , endocrinology , human cytomegalovirus , diabetes mellitus
Viral infections post‐renal transplant (Tx) impact on outcome. Increased rejection rates and decreased renal function secondary to acute CMV, EBV and HHV‐6 infections are well described. However, the clinical significance of a mere presence of these viruses on kidney tissue biopsy remains questionable. Thirty‐six kidney biopsies obtained from 17 renal transplants (five females) and two combined liver–kidney recipients (one female) were retrospectively evaluated. Age at Tx ranged from 1.7 to 17.2 yr (median = 7.4). Biopsies were performed as protocol biopsies or when renal function deteriorated, between 6 weeks and 11 yr post‐Tx (median = 1.2 yr). Immunosuppression included steroids and combination of tacrolimus/cyclosporin, mycophenolate mofetil/azathioprin and induction therapy. Fourteen patients received antiviral prophylaxis (ganciclovir/valganciclovir/acyclovir). Renal tissue was classified according to Banff ’97 criteria. Tissue CMV, EBV, HHV‐6 and HHV‐7 was analyzed by PCR. We used an estimation of GFR from average plasma Cystatin C (CysC) and slopes of 1/CysC to assess renal function. The 16/36 biopsies were positive for one virus; 5/36 biopsies were positive for two viruses. In the infected group, Banff ’97 scores for interstitial fibrosis (ci) and tubular degeneration/atrophy (ct) were significantly higher (p < 0.03 vs. the non‐infected group for both). The slope of 1/CysC, or the proportion of patients on antiviral prophylaxis, did not differ significantly between both groups. In conclusion, a significant number of kidney biopsies showed PCR positivity for CMV, EBV, HHV‐6 and HHV‐7. This was associated with a significantly higher Banff score for ci and ct; while renal function was not affected. Further controlled studies are required.