Abstract
Background: Viral infections are a significant cause of graft loss and dysfunction in kidney transplant recipients. Cytomegalovirus and BK polyomavirus have often been explained as the most common viral etiological agents. Objectives: The current study was undertaken to assess the prevalence of cytomegalovirus and BK polyomavirus infection in post-renal transplant individuals in a tertiary care centre in South India and also to study the histopathological changes of such infections in the kidney allograft biopsies. Patients and Methods: We conducted a retrospective investigation of 100 cases using archival renal biopsy specimens which were subjected to immunohistochemical stains to detect cytomegalovirus and BK polyoma virus. These findings were then correlated with the histopathological alterations detected in H&E sections. Results: We detected the prevalence of cytomegalovirus in 7% and BK polyoma virus in 3%. Cytomegalovirus was statistically associated with pre- and post-transplant infections along with diabetic status. We noted that, out of the seven patients who were immunohistochemically cytomegalovirus positive, only five had positive cytomegalovirus IgM status. With BK polyoma virus, we noted a statistical significance with pre- and posttransplant infections. However, we did not find evidence of cytomegalovirus and BK polyoma virus co-infection in any of the renal allograft biopsies. Conclusions: Routine immunohistochemical evaluation of cytomegalovirus and BK polyoma viral infections in kidney allograft recipients must be done, especially in those with preand post-transplant infections and diabetes.
Highlights
Viral infections are a significant cause of graft loss and dysfunction in kidney transplant recipients
Assessment of morphologic lesions The histological alterations/parameters studied in H&E stained sections were tubulitis, tubular atrophy, acute tubular necrosis, isometric vacuolization, interstitial fibrosis, interstitial inflammation whether acute or subacute or chronic, nuclear changes, vascular changes including any evidence of endothelial cell inclusions, casts, glomerular changes and manifestation of any recurrent renal diseases in the renal allograft biopsy
BK virus has been recently recognized as a cause of renal allograft dysfunction
Summary
Viral infections are a significant cause of graft loss and dysfunction in kidney transplant recipients. Patients and Methods: We conducted a retrospective investigation of 100 cases using archival renal biopsy specimens which were subjected to immunohistochemical stains to detect cytomegalovirus and BK polyoma virus. Cytomegalovirus (CMV) and BK virus has been described as the most common viral etiological agents in kidney allograft recipients in the West. Detection of such viral infection associated graft dysfunction requires a judicious decrease in CMV and BK virus in post-renal transplant immunosuppression and monitoring for acute rejection. Asymptomatic primary BK polyomavirus infection is seen in most individuals since early life It remains latent in the urinary tract and gets reactivated due to drug induced immunosuppression in renal transplant recipients. A high prevalence of BK virus nephropathy has been earlier reported from India in post renal transplant patients [2]
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