Polyomavirus allograft nephropathy: sequential assessment of histologic viral load, tubulitis, and graft function following changes in immunosuppression. Export

@article{citeulike:3134227, abstract = {Our initial cases of polyoma virus allograft nephropathy (PVAN) received pulse steroids due to anxiety about concomitant acute rejection triggered by the presence of tubulitis. However, our current policy is to reduce immunosuppression in all cases. The aim of this study was to determine whether clinical follow-up in these patient categories shows any differences in: (a) histologic viral load, (b) grade of tubulitis, and (c) graft function. Reduced viral load assessed within 8 weeks was seen in 4/20 (20.0\%) biopsies treated initially by increased immunosuppression, compared to 15/19 (83.3\%) biopsies treated with reduced immunosuppression (p = 0.001, Fisher's exact test). Yet, >70\% reversal of the rise in serum creatinine occurred in only 3/19 (15.8\%) and 1/19 (5.3\%) patients, respectively, in these two groups. Improved tubulitis was seen in 11/20 (55\%) of biopsies treated with steroids, despite the lack of beneficial effect on serum creatinine in 12/19 (63.1\%) instances. In biopsies not treated with any change in immunosuppression, the serum creatinine remained stable in 1/5 (20\%) and worsened in 4/5 (80\%) biopsies. These data demonstrate that in biopsies with PVAN and tubulitis, reduced immunosuppression is more effective in lowering viral load than steroid therapy. Lack of parallelism between viral load, tubulitis grade, and serum creatinine illustrates a complex interplay of viral and alloimmune factors leading to graft injury.}, address = {Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.}, author = {Celik, B. and Shapiro, R. and Vats, A. and Randhawa, P. S.}, citeulike-article-id = {3134227}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/14525598}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=14525598}, issn = {1600-6135}, journal = {American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons}, keywords = {bkv}, month = {November}, number = {11}, pages = {1378--1382}, posted-at = {2008-08-18 21:24:45}, priority = {4}, title = {Polyomavirus allograft nephropathy: sequential assessment of histologic viral load, tubulitis, and graft function following changes in immunosuppression.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/14525598}, volume = {3}, year = {2003} }

TY - JOUR ID - citeulike:3134227 L3 - citeulike-article-id:3134227 N2 - Our initial cases of polyoma virus allograft nephropathy (PVAN) received pulse steroids due to anxiety about concomitant acute rejection triggered by the presence of tubulitis. However, our current policy is to reduce immunosuppression in all cases. The aim of this study was to determine whether clinical follow-up in these patient categories shows any differences in: (a) histologic viral load, (b) grade of tubulitis, and (c) graft function. Reduced viral load assessed within 8 weeks was seen in 4/20 (20.0%) biopsies treated initially by increased immunosuppression, compared to 15/19 (83.3%) biopsies treated with reduced immunosuppression (p = 0.001, Fisher's exact test). Yet, >70% reversal of the rise in serum creatinine occurred in only 3/19 (15.8%) and 1/19 (5.3%) patients, respectively, in these two groups. Improved tubulitis was seen in 11/20 (55%) of biopsies treated with steroids, despite the lack of beneficial effect on serum creatinine in 12/19 (63.1%) instances. In biopsies not treated with any change in immunosuppression, the serum creatinine remained stable in 1/5 (20%) and worsened in 4/5 (80%) biopsies. These data demonstrate that in biopsies with PVAN and tubulitis, reduced immunosuppression is more effective in lowering viral load than steroid therapy. Lack of parallelism between viral load, tubulitis grade, and serum creatinine illustrates a complex interplay of viral and alloimmune factors leading to graft injury. IS - 11 JF - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons SN - 1600-6135 AD - Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. EP - 1382 TI - Polyomavirus allograft nephropathy: sequential assessment of histologic viral load, tubulitis, and graft function following changes in immunosuppression. VL - 3 SP - 1378 KW - bkv AU - Celik, B AU - Shapiro, R AU - Vats, A AU - Randhawa, PS PY - 2003/11// UR - http://view.ncbi.nlm.nih.gov/pubmed/14525598 ER -