Different patterns of BK and JC polyomavirus reactivation following renal transplantation

2010 ◽  
Vol 63 (8) ◽  
pp. 714-718 ◽  
Author(s):  
Baljit K Saundh ◽  
Stephen Tibble ◽  
Richard Baker ◽  
Kestutis Sasnauskas ◽  
Mark Harris ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Jc Virus ◽  
Teaching Hospitals ◽  
Renal Transplant Recipients ◽  
Plasma Samples ◽  
Jc Polyomavirus ◽  
Post Transplantation ◽  
Transplant Patients ◽  
Multiplex Pcr Assay

AimReactivation of latent BK polyomavirus (BKV) infection is relatively common following renal transplantation and BKV-associated nephropathy has emerged as a significant complication. JC polyomavirus (JCV) reactivation is less well studied. The aim of the study was to determine reactivation patterns for these polyomaviruses in renal transplant recipients using an in-house quantitative real-time multiplex PCR assay and IgG serological assays using recombinant BK and JC virus-like particles.MethodsRetrospective analysis of urine and plasma samples collected from 30 renal transplant patients from February 2004 to May 2005 at Leeds Teaching Hospitals NHS Trust. Samples were collected at 5 days and thereafter at 1, 3, 6 and 12 months post-transplantation.ResultsEight patients (26.7%) were positive for BK viruria; three of these patients submitted plasma samples and two had BK viraemia. Five patients (16.7%) were positive for JC viruria. A corresponding rise in BKV and JCV antibody titres was seen in association with high levels of viruria.ConclusionsDifferent patterns of reactivation were observed: BK viruria was detected after 3–6 months, and JC viruria was observed as early as 5 days post-transplantation. One patient had biopsy-proven BKV nephropathy. No dual infections were seen. In order to ensure better graft survival, early diagnosis of these polyomaviruses is desirable.

P1763TUBERCULOSIS IN RENAL TRANSPLANT RECEPIENTS - DO RITUXIMAB AND OTHER IMMUNOSUPRESSION HAVE A ROLE?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anupma Kaul ◽  
Dharmendra Bhaduria ◽  
Narayan Prasad ◽  
Amit Gupta
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Immunosuppressive Agents ◽  
Induction Agent ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Significant Difference ◽  
High Prevalence ◽  
Mean Time

Abstract Background and Aims Rituximab is an anti CD 20 agent used widely in renal transplant recipients. Its use is associated with various infections;however, its association with Tuberculosis (TB) is not well established and has not been studied in post renal transplantation patients. Method This is a single centre, retrospective analysis of 56 renal transplant recipients who received rituximab for various reasons and 287 post renal transplant patients who did not receive rituximab during the study period from January 2013 to June 2017. The association between use of rituximab and incidence of TB was studied. Other factors associated with tuberculosis were also investigated. Results Baseline characteristics were similar in both the groups. Mean time for occurrence of TB was 18.4 + 10.6 months after renal transplantation. Rituximab use was not significantly associated with tuberculosis or any other infection. Higher number of rejection episodes (60% vs 32.72%, p=0.029) was the only factor associated with greater incidence of TB. However, no specific type of rejection was associated with tuberculosis. Use of plasmapheresis in post transplant period for treatment of humoral rejections was associated with significantly higher incidence of TB (33.33% vs 13.41%, p=0.031), however when pre- transplant plasmapheresis was also considered, there was no significant difference. The choice of induction agent was not associated with higher incidence of TB. Conclusion Use of rituximab is not associated with higher incidence of TB when compared to other immunosuppressive agents. Routine screening and prophylaxis may not be advisable especially in a country like India with high prevalence of TB; as it will further delay transplantation and may adversely affect the outcome of the patients.

Mycophenolate mofetil, an inhibitor of inosine monophosphate dehydrogenase, causes a paradoxical elevation of GTP in erythrocytes of renal transplant patients

2004 ◽  
Vol 107 (1) ◽  
pp. 63-68 ◽  
Author(s):  
David GOLDSMITH ◽  
Elizabeth A. CARREY ◽  
Stephen EDBURY ◽  
Ryszard T. SMOLENSKI ◽  
Piotr. JAGODZINSKI ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Plasma Metabolites ◽  
Renal Transplant Recipients ◽  
Inosine Monophosphate Dehydrogenase ◽  
Inosine Monophosphate ◽  
Transplant Patients ◽  
Renal Transplant Patients ◽  
Monophosphate Dehydrogenase

The immunosuppressant MMF (mycophenolate mofetil) has increasingly replaced AZA (azathioprine) in renal transplantation. MMF is a prodrug of MPA (mycophenolic acid), which inhibits lymphocyte IMPDH (inosine monophosphate dehydrogenase), thereby drastically decreasing GTP concentrations essential to lymphocyte proliferation in vitro and in vivo. Erythrocyte GTP concentrations are commonly elevated in severe renal disease, but normalize following successful engraftment. Consequently, elevated GTP in renal transplant recipients might signal impending loss of immunosuppression and graft failure. In the present study, we compared erythrocyte nucleotides and plasma metabolites in two groups of 25 patients after renal transplantation, both receiving prednisolone and cyclosporin A, but one group receiving MMF and the other AZA. No patients had recent allograft biopsy evidence of rejection. Erythrocyte GTP concentrations at MMF commencement were 50.4±23.4 μmol/l. An increase occurred during the first 3 months after transplant when MMF was used de novo, stabilizing at 146.7±62.9 μmol/l after 4 months. This was significantly higher (P=2.5×10−6) than erythrocyte GTP (40.4±15.9 μmol/l) in the AZA group, which was essentially unchanged from values immediately after successful transplantation. The effect of MMF on erythrocyte GTP levels was reversible, since GTP levels fell when MMF therapy was terminated. The results demonstrate paradoxically high GTP concentrations in erythrocytes of renal transplant patients receiving MMF. MPA may stabilize reticulocyte IMPDH, allowing the protein to persist during erythropoiesis. This behaviour is in marked contrast with the decrease in GTP levels seen in white blood cells of patients on chronic MMF therapy.

scholarly journals Donor CYP3A5 Gene Polymorphism Alone Cannot Predict Tacrolimus Intrarenal Concentration in Renal Transplant Recipients

2020 ◽  
Vol 21 (8) ◽  
pp. 2976
Author(s):  
Mengyu Zhang ◽  
Soichiro Tajima ◽  
Tomohiro Shigematsu ◽  
Rao Fu ◽  
Hiroshi Noguchi ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Gene Polymorphism ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Renal Metabolism ◽  
Renal Tubular Cells ◽  
Transplant Patients ◽  
Graft Outcome ◽  
Cyp3a5 Gene

CYP3A5 gene polymorphism in recipients plays an important role in tacrolimus blood pharmacokinetics after renal transplantation. Even though CYP3A5 protein is expressed in renal tubular cells, little is known about the influence on the tacrolimus intrarenal exposure and hence graft outcome. The aim of our study was to investigate how the tacrolimus intrarenal concentration (Ctissue) could be predicted based on donor CYP3A5 gene polymorphism in renal transplant recipients. A total of 52 Japanese renal transplant patients receiving tacrolimus were enrolled in this study. Seventy-four renal biopsy specimens were obtained at 3 months and 1 year after transplantation to determine the donor CYP3A5 polymorphism and measure the Ctissue by liquid chromatography-tandem mass spectrometry (LC-MS-MS). The tacrolimus Ctissue ranged from 52 to 399 pg/mg tissue (n = 74) and was weak but significantly correlated with tacrolimus trough concentration (C0) at 3 months after transplantation (Spearman, r = 0.3560, p = 0.0096). No significant relationship was observed between the donor CYP3A5 gene polymorphism and Ctissue or Ctissue/C0. These data showed that the tacrolimus systemic level has an impact on tacrolimus renal accumulation after renal transplantation. However, donor CYP3A5 gene polymorphism alone cannot be used to predict tacrolimus intrarenal exposure. This study may be valuable for exploring tacrolimus renal metabolism and toxicology mechanism in renal transplant recipients.

scholarly journals MO920TRANSITION FROM GENERIC TO BRAND TACROLIMUS IN TUNISIAN RENAL TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Dorra Amor ◽  
Sahtout Wissal ◽  
A Ellouz ◽  
Ameni Abderrahman ◽  
Awatef Azzabi ◽  
...  
Keyword(s):  
Renal Transplant ◽  
University Hospital ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Blood Concentrations ◽  
Transplant Patients ◽  
Trough Blood ◽  
Bioequivalence Testing ◽  
Adult Volunteers

Abstract Background and Aims Due to unavailability of the generic tacrolimus, commonly used in renal transplant patients in Tunisia, all renal transplant switched to the Brand. No previous studies have assessed the pharmacokinetic differences of this generic tacrolimus compared to the brand. The aim of the present study was to evaluate the effect of this switch on the tacrolimus dose (D) and on the dose-adjusted tacrolimus trough blood concentrations (C0/D) in Tunisian renal transplant recipients. Method For the 255 renal transplant monitored in biochemestry department of Sahloul University hospital, 808tacrolimus trough concentration (C0) were collected from october 2018 to February 2020 and were divided to 406 C0 determination before switch and 402 after switch. The dose and the post-transplantation period was recorded for each C0. Results The generic tacrolimus doses used were significantly higher compared to the brand: 0,12 mg/kg [0,02-0,6] vs 0,11 mg/kg [0,02-0,22] p<0,001 and this was reported in different post graft periods: 0,17 [0,03-0,22] vs 0,13 [0,06-0,22] p<0,001in the 3 first months after the transplantation and 0,11 [0,02-0,48] vs 0,08 [0,02-0,22] p<0,001 above.The C0/D were significantly lowe runder the the generic tacrolimus compared to the brand 48,34ng/ml per mg/kg/day [11,58-210,00] vs77,35ng/ml per mg/kg/day[19,38-221,67]; p<0,001 and this was reported in different post graft periods: 71,12ng/ml per mg/kg/day [6,80, 451,56] vs80,9750ng/ml per mg/kg/day [17,33-458,80] p=0,017 in the 3 first months after the transplantation and 71,12ng/ml per mg/kg/day [6,80, 451,56] vs80,9750ng/ml per mg/kg/day [17,33-458,80] p=0,017 above. Dose needed to reach target tacrolimus C0 seems to be higher with the generic tacrolimus compared to the brand. Conclusion Approval of a generic is dependent on bioequivalence testing in healthy adult volunteers after a single dose, however studies on renal graft recipient populations after chronic use are needed to assed bioequivalence in this special population.

Increased Mortality Among Renal Transplant Patients With Invasive Pulmonary Aspergillus Infection

2018 ◽  
Vol 28 (4) ◽  
pp. 349-353 ◽  
Author(s):  
Baran Balcan ◽  
Umit Ozcelik ◽  
Aylin Ozsancakli Ugurlu ◽  
Mehtap Aydin ◽  
Serdar Nalcaci ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Univariate Analysis ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Aspergillus Infection ◽  
Transplant Patients ◽  
Renal Transplant Patients

Introduction: Renal transplantation is the most effective and preferred definite treatment option in patients with end-stage renal disease. Due to long-term immunesuppressive treatment, renal transplant recipients become vulnerable to opportunistic infections, especially to fungal infections. Method: This was a single-center, retrospective observational study of 438 patients who underwent renal transplantation between 2010 and 2016. Results: Thirty-eight renal transplant recipients who had lower respiratory tract infection with median age of 41.5 years were evaluated for invasive pulmonary aspergillus (IPA). Of these, 52.6% were female and 84.2% had living donors. Eleven of 38 lower respiratory patients were found to have IPA infection, 5 with proven infection. Compared to patients who did not have fungal pulmonary infection, patients with invasive aspergillus were older and had high fever, galactomannan levels, and leukocyte counts. Mortality was also higher in those patients. Having fever at the baseline and IPA infection was significantly associated with mortality in univariate analysis and remained related in multivariate model after adjustment for age, gender, and fever. Conclusion: Invasive pulmonary aspergillus infection is highly associated with increased mortality rates in renal transplant patients. Fungal pulmonary infections in immune-suppressed patients should be diagnosed and treated immediately in order to avoid the life-threatening complications and may greatly improve prognosis.

scholarly journals Torquetenovirus Serum Load and Long-Term Outcomes in Renal Transplant Recipients

2020 ◽  
Vol 9 (2) ◽  
pp. 440 ◽  
Author(s):  
Edmund J. Gore ◽  
António W. Gomes-Neto ◽  
Lei Wang ◽  
Stephan J. L. Bakker ◽  
Hubert G. M. Niesters ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Long Term Outcomes ◽  
Post Transplantation ◽  
Increased Risk ◽  
All Cause Mortality ◽  
One Year

Following transplantation, patients must take immunosuppressive medication for life. Torquetenovirus (TTV) is thought to be marker for immunosuppression, and TTV–DNA levels after organ transplantation have been investigated, showing high TTV levels, associated with increased risk of infections, and low TTV levels associated with increased risk of rejection. However, this has been investigated in studies with relatively short follow-up periods. We hypothesized that TTV levels can be used to assess long term outcomes after renal transplantation. Serum samples of 666 renal transplant recipients were tested for TTV DNA. Samples were taken at least one year after renal transplantation, when TTV levels are thought to be relatively stable. Patient data was reviewed for graft failure, all-cause mortality and death due to infectious causes. Our data indicates that high TTV levels, sampled more than one year post-transplantation, are associated with all-cause mortality with a hazard ratio (HR) of 1.12 (95% CI, 1.02–1.23) per log10 increase in TTV viral load, (p = 0.02). Additionally, high TTV levels were also associated with death due to infectious causes (HR 1.20 (95% CI 1.01–1.43), p = 0.04). TTV levels decrease in the years following renal transplantation, but remain elevated longer than previously thought. This study shows that TTV level may aid in predicting long-term outcomes, all-cause mortality and death due to an infectious cause in renal transplant patients sampled over one year post-transplantation.

scholarly journals BK Virus Infection:A Hidden Threat for Renal Transplant Recipients

2018 ◽  
Vol 43 (3) ◽  
pp. 101-107
Author(s):  
Afzalun Nessa ◽  
Nustrat Mannan ◽  
Shahina Tabassum ◽  
Sharimin Sultana ◽  
K.M Shahidul Islam
Keyword(s):  
Renal Transplant ◽  
Serum Creatinine ◽  
Graft Loss ◽  
Bk Virus ◽  
Urine Samples ◽  
Renal Transplant Recipients ◽  
Healthy Controls ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Transplant Patients

BK virus (BKV) infection has become an important concern for renal transplant recipients, as it may cause nephropathy in transplant patients receiving immunosuppressive therapy resulting in renal dysfunction and possibly, graft loss. This crosssectional study was carried out at the Department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2015 to June 2016, aimedto detect the incidence of BKV infection among transplant recipients from Bangladesh. A total of 30randomly selected adult renal transplant recipients and 15 healthy controls were included in this study.Their blood and urine samples were collected at 4 and 12 weeks of post transplantation, and tested for BKV DNA by quantitative real-time polymerase chain reaction. The serum creatinine levels were measured along with other routine investigations at the Department Biochemistry, BSMMU.Virological analysis showed, 8 (26.6%) patients had detectable BKV DNA at 4 weeks (1 month). Of them, 23.3% (7/30) had viruria and 3.3% (1/30) had viraemia. No BKV DNA was detected either in blood or in urine samples of healthy controls. Incidence of BKV infection found significantly higher (p<0.02) in transplant patients than healthy controls. However, their serum creatinine value was not significantly higher than that of the BKV DNA negative patients. At third month (12 weeks post transplantation), BKVviruria and/or viraemia were detected among 23.3% (7/30) patients where 13.3% (4/30) patients were newly detected who were previously ( at 4 weeks of transplant) negative; only 1 (3.3%) patient had both viraemia and viruria. There was significant variation (p<0.05) in mean serum creatinine value of BKV DNA positive and BKV DNA negative recipients at third month follow-up.Significantly higher incidence of BKV infection among transplant patients indicates thatit is very likely occurring in transplantation recipients, andBKV screening test should be included in routine postoperative follow-up investigations for early detection; and thus prevent the graft loss due to BKV nephropathy.

Sequence rearrangement in JC virus DNAs molecularly cloned from immunosuppressed renal transplant patients.

1991 ◽  
Vol 65 (5) ◽  
pp. 2422-2428 ◽  
Author(s):  
Y Yogo ◽  
T Kitamura ◽  
C Sugimoto ◽  
K Hara ◽  
T Iida ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Jc Virus ◽  
Transplant Patients ◽  
Sequence Rearrangement ◽  
Renal Transplant Patients

scholarly journals Calcium Metabolism following Renal Transplantation

1994 ◽  
Vol 31 (2) ◽  
pp. 125-128 ◽  
Author(s):  
Anne M Straffen ◽  
DJS Carmichael ◽  
Angela Fairney ◽  
B Hulme ◽  
M Snell
Keyword(s):  
Renal Transplantation ◽  
Calcium Homeostasis ◽  
End Stage Renal Disease ◽  
Post Transplantation ◽  
Dihydroxyvitamin D ◽  
1,25 Dihydroxyvitamin D ◽  
Transplant Patients ◽  
The Status ◽  
Stage Renal Disease ◽  
End Stage

Abnormalities of calcium homeostasis are a recognized feature of end-stage renal disease. The treatment of choice is renal transplantation, but this does not always result in normalization of the biochemical profile. Persistent hypercalcaemia is well documented and our study was undertaken to investigate the status of the calcium regulating hormones in renal patients post-transplantation. Serum calcium, parathyroid hormone, 1,25-dihydroxyvitamin D (1,25(OH)2D) and osteocalcin concentrations were measured in post-transplant patients. Twenty per cent of the patients had subnormal 1,25(OH)2D concentrations while 55% had biochemical evidence of hyperparathyroidism but only 5% were hypercalcaemic. Time elapsed since transplantation was not correlated with any of the analytes investigated and there was no relationship between persistent impairment of renal function and abnormalities of calcium homeostasis.

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