Journal Article

Incidence of polyomavirus‐nephropathy in renal allografts: influence of modern immunosuppressive drugs

Michael Mengel, Magali Marwedel, Jörg Radermacher, Gabriele Eden, Anke Schwarz, Hermann Haller and Hans Kreipe

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 18, issue 6, pages 1190-1196
Published in print June 2003 | ISSN: 0931-0509
Published online June 2003 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg072
Incidence of polyomavirus‐nephropathy in renal allografts: influence of modern immunosuppressive drugs

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Background. In recent years an increasing number of cases with polyomavirus (PV)‐nephropathy after renal transplantation were reported from several transplant centres. New, highly potent immunosuppressive drugs like tacrolimus or mycophenolate mofetil were accused as risk factors for this increase. However, data about the incidence of PV‐nephropathy in correlation to different immunosuppressive therapy concepts are lacking.

Methods. All renal transplant biopsies performed at Hannover Medical School between 1999 and 2001 (n=1276) were immunohistochemically screened for the presence of PV‐specific proteins. The results were correlated to the different immunosuppressive therapy protocols and patients with PV‐nephropathy were compared with a matched control group.

Results. PV‐nephropathy was found in <1% of all investigated allograft biopsies (11/1276) and in ∼1% of all patients (7/638), respectively. All patients being immunohistochemically positive for PV‐specific proteins also showed the typical morphological changes of PV‐nephropathy. Four out of seven patients with PV‐nephropathy were under triple immunosuppression comprising tacrolimus and mycophenolate mofetil. Under this immunosuppressive therapy protocol an eight times higher incidence and a 13 times higher risk (multivariate odds ratio 12.7) of PV‐nephropathy was observed in our patients compared with the control group.

Conclusions. PV‐nephropathy is a rare but serious complication after renal transplantation. A small group of patients under intensive immunosuppression comprising tacrolimus in combination with mycophenolate mofetil has a significantly increased risk of acquiring this deleterious complication.

Keywords: polyomavirus; renal transplantation

Journal Article.  4451 words.  Illustrated.

Subjects: Nephrology

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