Abstract
Polyomavirus-associated nephropathy is diagnosed in 2–8% of pediatric renal transplants and often precedes renal allograft dysfunction. Without intervention, however, significant graft dysfunction is observed in more than 50% of cases, although progressive early graft loss is reported in only three of 32 (9%) of cases. No specific treatment is available, but early decrease in immunosuppression is followed by declining human polyomavirus type 1 (BK virus) replication and improved outcome. The data suggest differences between pediatric and adult kidney transplantation. Possibly, pediatric patients might be able to mount a more vigorous BK virus-specific immune response than adult patients under similar modulation of immunosuppression. Also the role of cidofovir and leflunomide is still unresolved in pediatric patients. Larger prospective trials are needed to better define the impact of BK virus immunity for replication and disease as well as the role of reducing immunosuppression with or without cidofovir or leflunomide in pediatric transplant patients.
Highlights
Kidney transplantation is the treatment of choice for children with end-stage renal disease, showing improvingPediatr Nephrol (2007) 22:1243–1250 organ and patient survival over the past decade [1]
For the purposes of this review, we will focus on human polyomavirus type 1 [BK virus (BKV)] infection, replication, and disease in pediatric kidney transplant recipients
PVAN polyomavirus-associated nephropathy, N/A not available, EM electron microscopy, PCR polymerase chain reaction, RED restriction enzyme digestion, KT kidney transplantation, HIA hemagglutination inhibition assay, IF indirect immunofluorescence, KD kidney disease, KDI kidney disease treated with immunosuppression, VLP virus-like particles, Pt patient, * requires > 106 particles per ml and does not distinguish between BKV and JC virus was associated with BKV nephropathy, whereas calcineurin inhibitor choice [tacrolimus vs. cyclosporin A (CyA)] and basiliximab induction were not associated with viruria, viremia, or nephropathy [15]
Summary
Kidney transplantation is the treatment of choice for children with end-stage renal disease, showing improving. Pediatr Nephrol (2007) 22:1243–1250 organ and patient survival over the past decade [1] Part of this success is based on falling rates of acute allograft rejection, albeit at the expense of a rising number of infectious complications posttransplant [2]. For the purposes of this review, we will focus on human polyomavirus type 1 [BK virus (BKV)] infection, replication, and disease in pediatric kidney transplant recipients. Evaluation of BKV viruria by electron microscopy (EM) typically requires a viral concentration of 106–107 particles/ml and is not as sensitive as polymerase chain reaction (PCR) This limited sensitivity may account for two cases of BKV viremia without concomitant viruria, or alternatively point to de novo infection in these patients.
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