Common viral infections in kidney transplant recipients

Infection with cytomegalovirus (CMV) remains a major problem in kidney transplant recipients, resulting in serious infectious complications and occasionally mortality. Accumulating evidence indicates that natural killer cell immunoglobulin-like receptors (KIRs) and their ligands affect the susceptibility to various diseases, including viral infections (e.g., CMV infection). We investigated whether KIR genes and their ligands affect the occurrence of CMV infection in a group of 138 kidney transplant recipients who were observed for 720 days posttransplantation. We typed the recipients for the presence of KIR genes (human leukocyte antigen C1 [HLA-C1], HLA-C2, HLA-A, HLA-B, and HLA-DR1) by polymerase chain reaction with sequence-specific primers. The multivariate analysis revealed that the lack of KIR2DS2 (p = 0.035), the presence of KIR2DL3 (p = 0.075), and the presence of KIR2DL2–HLA-C1 (p = 0.044) were risk factors for posttransplant CMV infection. We also found that a lower estimated glomerular filtration rate (p = 0.036), an earlier time of antiviral prophylaxis initiation (p = 0.025), lymphocytopenia (p = 0.012), and pretransplant serostatus (donor-positive/recipient-negative; p = 0.042) were independent risk factors for posttransplant CMV infection. In conclusion, our findings confirm that the KIR/HLA genotype plays a significant role in anti-CMV immunity and suggest the contribution of both environmental and genetic factors to the incidence of CMV infection after kidney transplantation.

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Impact of Desensitization on Antiviral Immunity in HLA-Sensitized Kidney Transplant Recipients

Journal of Immunology Research ◽

10.1155/2017/5672523 ◽

2017 ◽

Vol 2017 ◽

pp. 1-24 ◽

Cited By ~ 16

Author(s):

Mieko Toyoda ◽

Bong-Ha Shin ◽

Shili Ge ◽

James Mirocha ◽

David Thomas ◽

...

Keyword(s):

Kidney Transplant ◽

Viral Infections ◽

Nk Cell ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Mortality Factors ◽

Lymphocyte Depletion ◽

Increased Risk ◽

Viral Infection Status ◽

Ebv Viremia

Viral infections represent significant morbidity and mortality factors in kidney transplant recipients, with CMV, EBV, and BKV infections being most common. Desensitization (DES) with IVIg and rituximab with/without plasma exchange followed by kidney transplantation with alemtuzumab induction increased successful transplant rates in HLA-sensitized patients but may represent an increased risk for viral infections due to severe lymphocyte depletion. Here, we report on the posttransplant viral infection status in 372 DES versus 538 non-DES patients. CMV and EBV viremia were significantly lower in DES patients, while BKV viremia was similar. This trend was observed primarily in CMV sero(−), EBV sero(+), and sero(−) patients. No patient developed PTLD. The incidence of BKAN, allograft, and patient survival was similar in both groups. These viral infections were not associated with subsequent allograft rejection which occurred within 6 months after the infection.Conclusions.The IVIg + rituximab desensitization combined with alemtuzumab induction with triple immunosuppression maintenance does not increase the risk for CMV, EBV, and BKV infections. Possible factors include, in addition to posttransplant antiviral prophylaxis and PCR monitoring, presence of memory T cells and antibodies specific to CMV and likely EBV, NK cell-mediated ADCC despite lymphocyte depletion, elimination of EBV and CMV reservoirs by rituximab and alemtuzumab, and use of IVIg with antiviral properties.

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Association of immune cell function assay with protocol biopsy findings and viral infections in well matched kidney transplant recipients

Clinical Nephrology ◽

10.5414/cnp74123 ◽

2010 ◽

Vol 74 (08) ◽

pp. 123-131 ◽

Cited By ~ 12

Author(s):

I. Helanterä ◽

P. Koskinen

Keyword(s):

Kidney Transplant ◽

Cell Function ◽

Viral Infections ◽

Immune Cell ◽

Immune Cell Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Protocol Biopsy

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Investigation of Intrarenal Viral Infections in Kidney Transplant Recipients Unveils an Association between Parvovirus B19 and Chronic Allograft Injury

The Journal of Infectious Diseases ◽

10.1086/596053 ◽

2009 ◽

Vol 199 (3) ◽

pp. 372-380 ◽

Cited By ~ 17

Author(s):

Luisa Barzon ◽

Luisa Murer ◽

Monia Pacenti ◽

Maria Angela Biasolo ◽

Manuela Della Vella ◽

...

Keyword(s):

Kidney Transplant ◽

Viral Infections ◽

Parvovirus B19 ◽

Transplant Recipients ◽

Kidney Transplant Recipients

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A Comparison Study of Coronavirus Disease 2019 Outcomes in Hospitalized Kidney Transplant Recipients

Kidney360 ◽

10.34067/kid.0005652020 ◽

2021 ◽

pp. 10.34067/KID.0005652020

Author(s):

Sherry G Mansour ◽

Divyanshu Malhotra ◽

Michael Simonov ◽

Yu Yamamoto ◽

Tanima Arora ◽

...

Keyword(s):

Kidney Transplant ◽

Viral Infections ◽

Kidney Injury ◽

High Rate ◽

Comparison Study ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Black Race ◽

Vasopressor Use ◽

Larger Sample

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect any human host, but kidney transplant recipients (KTR) are considered more susceptible based on previous experience with other viral infections. We evaluated rates of hospital complications between SARS-CoV-2 positive KTR and comparator groups. Methods. We extracted data from the electronic health record on hospitalized patients with SARS-CoV-2 testing at six hospitals from March 4th through September 9th, 2020. We compared outcomes between SARS-CoV-2 positive KTR and controls: SARS-CoV-2 positive non-KTR, SARS-CoV-2 negative KTR and SARS-CoV-2 negative non-KTR. Results. Of 31,540 inpatients, 3213 tested positive for SARS-CoV-2. There were 32 SARS-CoV-2 positive and 224 SARS-CoV-2 negative KTR. SARS-CoV-2 positive KTR had higher ferritin levels [1412 (748,1749) vs. 553 (256,1035), p<0.01] compared to SARS-CoV-2 positive non-KTR. SARS-CoV-2 positive KTR had higher rates of ventilation (34% vs. 14%, p<0.01; vs. 9%, p<0.01; vs. 5%, p<0.01), vasopressor use (41% vs. 16%, p<0.01; vs. 17%, p<0.01; vs. 12%, p<0.01) and acute kidney injury (AKI) (47% vs. 15%, p<0.01; vs. 23%, p<0.01; vs. 10%, p<0.01) compared to SARS-CoV-2 positive non-KTR, SARS-CoV-2 negative KTR, and SARS-CoV-2 negative non-KTR, respectively. SARS-CoV-2 positive KTR continued to have increased odds of ventilation, vasopressor use and AKI compared to SARS-CoV-2 positive non-KTR independent of Elixhauser score, Black race and baseline eGFR. Mortality was not significantly different between SARS-CoV-2 positive KTR and non-KTR, but there was a notable trend towards higher mortality in SARS-CoV-2 positive KTR (25% vs. 16%, p=0.15, respectively). Conclusion. Hospitalized SARS-CoV-2 positive KTR had a high rate of mortality and hospital complications such as requiring ventilation, vasopressor use, and AKI. Additionally they had higher odds of hospital complications compared to SARS-CoV-2 positive non-KTR after adjusting for Elixhauser score, Black race and baseline eGFR. Future studies with larger sample size of KTR need to validate our findings.

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