De novomalignancies in renal transplant recipients: experience at a single center with 1882 transplant patients over 39 yr

Abstract Introduction/Objective Human BK polyomavirus nephropathy (BKVN) occurs in up to 10% of renal transplant recipients, and can result in graft loss. Transplant biopsy is the gold standard to diagnose BKVN, and SV40 immunohistochemical (IHC) staining is helpful in confirming the diagnosis. BKVN is uncommon outside the setting of renal transplantation. To understand more about its occurrence in other contexts, we reviewed our renal biopsies files for cases of BKVN. Methods Our renal biopsy files for the past 20 years were reviewed for all cases with a diagnosis of BKVN or polyoma virus infection, and the clinical characteristics of the affected patients noted. Results Evidence of BKVN was found in 44 renal biopsies, of which 39 (86%) were renal transplant patients. Of the remaining five patients (14%), two had undergone heart transplantation, one lung transplantation, one was undergoing chemotherapy for acute lymphoblastic leukemia, and one patient had active HIV infection. All patients had elevated serum creatinine, and four out of five patients had documented BK viremia. Four of the five biopsies showed typical tubular injury with viral nuclear cytopathic changes (inclusions). In the lung transplant patient, the biopsy showed advanced chronic tubulointerstitial injury without distinct viral inclusions, but SV40 staining confirmed the presence of BK virus antigen. Conclusion The BKVN is distinctly uncommon outside the context of kidney transplantation. In our series, 14% of patients with BKVN were not kidney transplant recipients, but all were immune compromised in some fashion. The pathologic features of BKVN appear similar, regardless of whether the host is a renal transplant recipient or not. Although uncommon, it is important to consider the possibility of BKVN in non-renal transplant patients with persistent or progressive renal dysfunction.

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BK AND JC VIRUS INFECTIONS AMONG RENAL TRANSPLANT RECIPIENTS - A SINGLE CENTER RETROSPECTIVE REPORT FROM DENMARK

Transplantation Journal ◽

10.1097/00007890-201007272-01278 ◽

2010 ◽

Vol 90 ◽

pp. 667

Author(s):

L. A. Øzbay

Keyword(s):

Renal Transplant ◽

Jc Virus ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Virus Infections ◽

Single Center ◽

Retrospective Report

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Outcomes in Renal Transplant Recipients With Lupus Nephritis—A Single–Center Experience and Review of the Literature

Transplantation Proceedings ◽

10.1016/j.transproceed.2016.02.061 ◽

2016 ◽

Vol 48 (5) ◽

pp. 1489-1493 ◽

Cited By ~ 9

Author(s):

J. Gołębiewska ◽

A. Dębska–Ślizień ◽

B. Bułło–Piontecka ◽

B. Rutkowski

Keyword(s):

Renal Transplant ◽

Lupus Nephritis ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Review Of The Literature ◽

Single Center ◽

Single Center Experience

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THE INCIDENCE AND SEVERITY OF TACROLIMUS-ASSOCIATED ARTERIOLOPATHY IN LONG-TERM TACROLIMUS-TREATED RENAL TRANSPLANT RECIPIENTS. A FIVE-YEAR FOLLOW-UP AT A SINGLE CENTER.

Transplantation Journal ◽

10.1097/00007890-200607152-02656 ◽

2006 ◽

Vol 82 (Suppl 2) ◽

pp. 942-943

Author(s):

&NA;

Keyword(s):

Renal Transplant ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Single Center

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CD4+CD25+CD127-Foxp3+ and CD8+CD28- Tregs in Renal Transplant Recipients: Phenotypic Patterns, Association With Immunosuppressive Drugs, and Interaction With Effector CD8+ T Cells and CD19+IL-10+ Bregs

Frontiers in Immunology ◽

10.3389/fimmu.2021.716559 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mostafa G. Aly ◽

Eman H. Ibrahim ◽

Hristos Karakizlis ◽

Rolf Weimer ◽

Gerhard Opelz ◽

...

Keyword(s):

Renal Transplant ◽

Negative Impact ◽

Immunosuppressive Drugs ◽

Acute Cellular Rejection ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Regulatory Cells ◽

Transplant Patients ◽

Antibody Induction ◽

Cellular Rejection

IntroductionGaps still exist regarding knowledge on regulatory cells in transplant recipients. We studied the phenotypic patterns of CD4+, CD8+CD28- Tregs, and CD19+IL-10+ Bregs in the blood of healthy controls (HC), end-stage kidney disease patients (ESKD), early and late stable renal transplant recipients (Tx), and transplant recipients with steroid-treated acute cellular rejection 1 week–3 months after successful treatment. We also investigated the relationship between immunosuppressive drugs and the aforementioned regulatory cells in transplant recipients.MethodsWe recruited 32 HC, 83 ESKD, 51 early Tx, 95 late Tx, and 9 transplant patients with a recent steroid-treated acute cellular rejection. Besides CD19+IL-10+ Bregs, we analyzed absolute and relative frequencies of CD4+CD25+CD127-Foxp3+ Tregs and CD8+CD28- Tregs and their expression of IL-10, TGF-ß, IFN-g, and Helios.ResultsWe found a negative correlation between absolute CD4+CD25+CD127-Foxp3+ Treg and relative CD19+IL-10+ Breg frequencies in early Tx recipients (r=-0.433, p=0.015, n=31). In that group, absolute CD4+CD25+CD127-Foxp3+ Tregs were negatively associated with steroid dose and tacrolimus trough levels (r=-0.377, p = 0.021, n=37; r=-0.43, p=0.033, n=25, respectively), opposite to IL-10+ Bregs, whose frequency apparently was not negatively affected by potent immunosuppression early posttransplant. We found also lower CD4+CD25+CD127-Foxp3+ Tregs in patients treated with basiliximab or rATG as compared with ESKD patients (p=0.001 and p <0.001, respectively). No difference in absolute IL-10+ Bregs could be detected among these 3 patient groups. Early Tx recipients showed lower CD4+CD25+CD127-Foxp3+ Tregs within 3 months of antibody induction than after 3 months (p = 0.034), whereas IL-10+ Bregs showed higher relative counts during the first 3 months post antibody induction than after 3 months (p = 0.022). Our findings suggest that IL-10+ Bregs decrease with time posttransplantation independent of the effect of antibody induction and dose of other immunosuppressive drugs.ConclusionThese findings suggest that CD19+IL-10+ Bregs and CD4+CD25+CD127-Foxp3+ Tregs behave in opposite ways during the early posttransplant period, possibly due to a predominant negative impact of high doses of immunosuppressants on Tregs. CD19+IL-10+Bregs do not seem to be suppressed by antibody induction and early potent immunosuppression with chemical drugs.

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