Does polyomavirus infection induce renal failure in cardiac transplant recipients?

Abstract

POLYOMAVIRUS infections due to BK virus (BKV) or JC virus (JCV) are usually asymptomatic in the general population but may be revealed by clinical signs in immunocompromised patients. In kidney transplant recipients, polyomaviruses may be responsible for acute tubulointerstitial nephropathy (ATIN) and loss of graft. Many cases have been described over the past 4 years. The diagnosis may be suggested by the presence of decoy cells on urine microscopy (UM). Decoy cells are exfoliated epithelial cells which are either tubular or urothelial that resemble urothelial carcinoma cells. They are dystrophic with nuclear hyperchromatism and high nucleoplasmic index. In electron microscopy (EM), the presence of viral intranuclear inclusions of 40 nm diameter is typical of decoy cells. To our knowledge, the occurrence of ATIN in other organ transplant recipients has never been previously reported. Renal insufficiency frequently occurs following heart transplantation. It occurs at an early stage and evolves over 6 to 10 years. Due to the excellent transplant survival rate, patients will possibly undergo dialysis. The etiology of this type of renal insufficiency is often related to chronic toxicity of cyclosporin A. The aim of this study was to determine if polyomavirus could provoke ATIN in heart transplant recipients and if these infections are associated with renal insufficiency in these patients.