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NDT Advance Access published online on December 10, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn671
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© The Author [2008].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Risk factors for polyoma virus nephropathy

Olivier Prince1,2, Spasenija Savic2, Michael Dickenmann3, Jürg Steiger3, Lukas Bubendorf2 and Michael J. Mihatsch2

1 Geriatric Medicine 2 Institute for Pathology 3 Transplantation Immunology and Nephrology, University Hospital Basel, Switzerland

Correspondence and offprint requests to: Michael J. Mihatsch, Institut für Pathologie Basel, Schönbeinstrasse 40, CH-4031 Basel, Switzerland. Tel: +41-61-3287872; Fax:+41-61-2653194; E-mail: mjmihatsch{at}uhbs.ch



  Abstract

Background. Polyoma virus-associated nephropathy (PVN) is a common cause of renal transplant failure. The risk factors for the development of PVN have not yet been studied in large cohorts of patients for periods of 20 years.

Methods. We collected clinical, renal biopsy and urinary cytology data from all patients with renal transplantations performed at the University Hospital of Basel from 1985 to 2005.

All patients with a renal biopsy and urine cytology were included (n = 880). Renal transplants were divided into three groups, according to evidence of polyoma virus (PV) infection (decoy cells in the urine) and biopsy-proven PVN:

  1. Renal transplants without evidence of a PV infection (n = 751).
  2. Renal transplants with PV reactivation, e.g. decoy cell (DC) found by urinary cytology, but without PVN (n = 90).
  3. Renal transplants with PVN (n = 39).

Results. The prevalence of biopsy-proven PVN in this cohort of patients was 3.3%. Immunosuppression with mycophenolate and/or tacrolimus, ATGAM, male gender of the recipient and a higher number of transplant rejection episodes were factors significantly associated with PVN development.

Conclusions. The most important risk factors for the development of PVN are acute rejection and ATGAM used as induction therapy as well as tacrolimus and mycophenolate as maintenance therapy. Therefore, we conclude that patients with tacrolimus and mycophenolate maintenance therapy should be carefully monitored for the development of PVN.

Keywords: BK virus; decoy cell; polyoma virus-associated nephropathy; renal transplantation; risk factors

Received for publication: 14. 4.08
Accepted in revised form: 7.11.08


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