Prospective monitoring of polyomavirus BK replication and impact of pre-emptive intervention in pediatric kidney recipients

F. Ginevri, A. Azzi, H. H. Hirsch, S. Basso, I. Fontana, M. Cioni, S. Bodaghi, V. Salotti, A. Rinieri, G. Botti, F. Perfumo, F. Locatelli, P. Comoli

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Polyoma BK virus (BKV)-associated nephropathy (PVAN) is a relevant cause of poor renal allograft survival. In a prospective analysis, we monitored BKV DNA in blood and urine samples from 62 consecutive pediatric kidney recipients. In patients with BKV replication, we analyzed the impact of reduction of maintenance immunosuppression on viral load kinetics and PVAN in patients with BKV replication. BKV-specific immunity was concomitantly evaluated on blood samples of viremic patients, by measuring the frequency of BKV-specific interferon-γ-producing and cytotoxic T cells, and BKV IgG antibody levels. At a median follow-up of 24 months, BK viruria was observed in 39 of 62 patients, while BK viremia developed in 13 patients (21%). In all viremic patients, immunosuppression reduction resulted in the clearance of viremia, and prevented development of PVAN, without increasing the rate of acute rejection or causing graft dysfunction. As a consequence of immunosuppression adjustment, an expansion of BKV-specific cellular immunity was observed that coincided with viral clearance. We conclude that treating pediatric kidney transplant patients pre-emptively with immunosuppression reduction guided by BKV DNA in blood is safe and effective to prevent onset of PVAN. BKV-specific cellular immunity may be useful to guide this intervention.

Original languageEnglish
Pages (from-to)2727-2735
Number of pages9
JournalAmerican Journal of Transplantation
Volume7
Issue number12
DOIs
Publication statusPublished - Dec 2007

Fingerprint

BK Virus
Pediatrics
Kidney
Immunosuppression
Viremia
Virus Replication
Cellular Immunity
Transplants
Polyomavirus
DNA
Viral Load
Interferons
Allografts
Immunity
Immunoglobulin G
Maintenance
Urine

Keywords

  • Cellular immunity
  • Humoral immunity
  • Pediatric kidney transplantation
  • Polyomavirus BK
  • Pre-emptive therapy

ASJC Scopus subject areas

  • Immunology

Cite this

Prospective monitoring of polyomavirus BK replication and impact of pre-emptive intervention in pediatric kidney recipients. / Ginevri, F.; Azzi, A.; Hirsch, H. H.; Basso, S.; Fontana, I.; Cioni, M.; Bodaghi, S.; Salotti, V.; Rinieri, A.; Botti, G.; Perfumo, F.; Locatelli, F.; Comoli, P.

In: American Journal of Transplantation, Vol. 7, No. 12, 12.2007, p. 2727-2735.

Research output: Contribution to journalArticle

Ginevri, F. ; Azzi, A. ; Hirsch, H. H. ; Basso, S. ; Fontana, I. ; Cioni, M. ; Bodaghi, S. ; Salotti, V. ; Rinieri, A. ; Botti, G. ; Perfumo, F. ; Locatelli, F. ; Comoli, P. / Prospective monitoring of polyomavirus BK replication and impact of pre-emptive intervention in pediatric kidney recipients. In: American Journal of Transplantation. 2007 ; Vol. 7, No. 12. pp. 2727-2735.
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