| Putative episodes of T-cell-mediated rejection in patients with sustained BK viruria but no viremia. | |
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MedLine Citation:
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PMID: 22691957 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Polyomavirus BK (BKV) infection characterized by viruria alone is considered to be of little clinical significance, but this issue has not been systematically studied. METHODS: We studied 230 patients with sustained viruria from whom multiple samples taken after a median of 877 days (range, 24-2739) showed no progression to viremia or nephropathy. Biopsies satisfying Banff thresholds for inflammation and tubulitis in the presence of viruria but negative for BKV stains were designated as putative T-cell-mediated acute rejection. RESULTS: Compared with no viruria (n=515), sustained viruria was associated with more putative rejection episodes (0.62 vs. 0.33 per patient, P=0.006) and greater incidence of steroid resistance (36.2% vs. 19.6%, P=0.002). Most putative rejection episodes (52.1%) occurred concurrently with viruria, with a minority before (7.8%) or after (40.1%) BKV clearance. Steroid resistance was more frequent in putative rejection with concurrent viruria (48.6%), compared with rejection before (9.1%) or after (26.0%) viral clearance. These observations remained valid even on a separate analysis of patients with BKV load 1E+07 copies per mL or less. As assessed by the slope of reciprocal serum creatinine levels, accelerated deterioration of graft function resulted from rejection episodes occurring more than 2 years after transplantation. CONCLUSIONS: These observations indicate that intrarenal viral replication in sustained viruria is frequently associated with putative acute rejection. The implications of this association on the development of immune tolerance deserve further investigation. |
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Authors:
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Kosuke Masutani; Ron Shapiro; Amit Basu; Henkie Tan; Toshiharu Ninomiya; Parmjeet Randhawa |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Transplantation Volume: 94 ISSN: 1534-6080 ISO Abbreviation: Transplantation Publication Date: 2012 Jul |
Date Detail:
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Created Date: 2012-07-06 Completed Date: 2012-09-11 Revised Date: 2013-04-16 |
Medline Journal Info:
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Nlm Unique ID: 0132144 Medline TA: Transplantation Country: United States |
Other Details:
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Languages: eng Pagination: 43-9 Citation Subset: IM |
Affiliation:
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Division of Transplant Pathology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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BK Virus
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isolation & purification* Graft Rejection* Humans Kidney Transplantation / adverse effects* Polyomavirus Infections / urine, virology* Retrospective Studies T-Lymphocytes / immunology* Tumor Virus Infections / urine, virology* Urine / virology Viral Load Viremia / virology |
| Grant Support | |
ID/Acronym/Agency:
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R01 AI 51227/AI/NIAID NIH HHS; R01 AI051227-08/AI/NIAID NIH HHS; R01 AI063360-05/AI/NIAID NIH HHS |
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