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T‐cell adoptive immunotherapy for BK nephropathy in renal transplantation
Author(s) -
Jahan Sadia,
Scuderi Carla,
Francis Leo,
Neller Michelle A,
Rehan Sweera,
Crooks Pauline,
Ambalathingal George R,
Smith Corey,
Khanna Rajiv,
John George T.
Publication year - 2020
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13399
Subject(s) - medicine , bk virus , transplantation , nephropathy , biopsy , kidney transplantation , hemodialysis , renal biopsy , nephrectomy , tacrolimus , gastroenterology , urology , immunology , kidney , endocrinology , diabetes mellitus
BK virus (BKPyV) nephropathy occurs in 1%‐10% of kidney transplant recipients, with suboptimal therapeutic options. Case A 54‐year‐old woman received a transplant in March 2017. BKPyV was detected at 1.5 × 10 2 copies/mL within a month, necessitating halving of mycophenolate and addition of leflunomide. Allograft histology in December showed polyomavirus nephropathy treated with intravenous immunoglobulin and cessation of mycophenolate. In February 2018, cidofovir and ciprofloxacin were commenced. In April, tacrolimus was reduced while introducing everolimus. A second graft biopsy in August showed increasing polyoma virus infection and a subsequent biopsy in September for worsening renal function showed 30% of tubular reactivity for simian virus 40 (SV40). Allogeneic BKPyV‐reactive T cells were generated from the patient's daughter and infused over 10 sessions starting late September. The fourth allograft biopsy in November 2018 demonstrated involvement of BKPyV in 50% of tubules. Allograft function continued to decline, requiring hemodialysis from December 2018. Allograft nephrectomy after 6 months showed <1% SV40 in preserved tubules and 80% interstitial fibrosis. Discussion We conclude that the T‐cell adoptive immunotherapy reduced BKPyV load significantly despite extensive infection, but attendant fibrosis and tubular atrophy led to graft failure. Early intervention with T‐cell therapy may prove efficacious in BKPyV nephropathy.