Polyomavirus Associated Nephropathy In Renal Transplant Recipients:a Single-center Retrospective Study

Obiective:To summarize the clinical manifestations,experience of diagnosis and treatment and prognosis of polyomavirus associated nephropathy(PVAN) after renal transplantation in our single center, in order to gain a more effectively prevention and treatment arrangement, consequently improve the survival rate of the renal allografts and recipients.Methods:26cases of polyomavirus associated nephropathy(PVAN) after renal transplantation which were diagnosed in the nephrology department of the First Affiliated Hospital,Zhejiang University between July2011and December2013were included.Clinical manifestations,experience of diagnosis and treatment,and prognosis are described.Results: Of the26recipients,53.8%(14/26) is male.The average age of the recipients was35(21-50) years old.92.3%(24/26) kidney primary disease is chronic glomerulonephritis.14recipients recieved cadaveric donor while12living donor.The average number of HLA mismath is2.7.Two recipients’PRA is positive and only one is retransplanted.21recipients recieved immune induction therapy.The median time from operation to diagnosis of PVAN is10months.All recipients showed a continuely elevated serum creatinine level.4recipients were companied with proteinuria and/or hematuresis while others not.3recipients had ureteral stent.16recipients were searched for decoy cells,75%(12/16) are positive.5recipients suffered acute rejection before diagnosis of PVAN,and2recipients were combined with acute rejection while being diagnosed of PVAN. Since diagnosis of PVAN,immunosuppressive therapy was reduced. One died of severe lung infections when being diagnosed of PVAN.After a median follow-up of17months,72%(18/25) of the recipients had a stable renal function,whlile others progressed and renal allograft loss occured in three of them.Using Kaplan-Meier method,we find recipients suffering acute rejection during or after the diagnosis of PVAN have a higher risk of allograft dysfunction.Conclusions:PVAN occurs early after renal transplantation, and is apt to progress to allograft dysfunction.Cautious immunosuppression reduction can keep majority renal function stable.Recipients suffering acute rejection during or after the diagnosis of PVAN have a higher risk of allograft dysfunction.