Effects of Parvovirus B19 Infection in Renal Transplant Recipients: A Retrospective Review of Three Cases

Abstract

Parvovirus B19 (PVB19) is a DNA virus which causes clinically relevant infection in renal transplant recipients (RTR) leading to significant morbidity. Manifestations include erythropoietin resistant anemia, proteinuria, and glomerulosclerosis in the allograft. Severe infection may require administration of intravenous immunoglobulin, reduction in immunosuppression and transfusions. The major challenge in managing and preventing the infection in RTR involves the act of balancing the decreased level of immunosuppression and the risk of rejection. The objective of this article is to understand the importance of PVB19 infection and its outcome in RTR. We reviewed the medical records of three RTR with confirmed PVB19 infection and recorded patient information including demographics, clinical and laboratory data, management, and outcome. The average time of occurrence of PVB19 infection as transplant was 8.6 weeks and they presented with symptomatic anemia. Elevated creatinine values were noted in two of them. Following treatment, anemia improved and creatinine values returned to baseline. One of them developed an early relapse and had to be treated once again similarly. We emphasize the importance of maintaining a high index of suspicion for PVB19 infection in patients with anemia in the posttransplant phase, especially in patients on higher doses of immunosuppressants. Early and proper treatment can prevent worsening clinical condition and possible effects on the allograft.

Keywords

allograft - anemia - immunosuppression - intravenous immunoglobulin - parvovirus B19 - renal transplant

• References

• 1 Lee PC, Hung CJ, Lin YJ, Wang JR, Jan MS, Lei HY. A role for chronic parvovirus B19 infection in liver dysfunction in renal transplant recipients?. Transplantation 2002; 73 (10) 1635-1639
• 2 Eid AJ, Chen SF ; AST Infectious Diseases Community of Practice. Human parvovirus B19 in solid organ transplantation. Am J Transplant 2013; 13 (Suppl. 04) 201-205
• 3 Liefeldt L, Plentz A, Klempa B , et al. Recurrent high level parvovirus B19/genotype 2 viremia in a renal transplant recipient analyzed by real-time PCR for simultaneous detection of genotypes 1 to 3. J Med Virol 2005; 75 (1) 161-169
• 4 Waldman M, Kopp JB. Parvovirus B19 and the kidney. Clin J Am Soc Nephrol 2007; 2 (Suppl. 01) S47-S56
• 5 Eid AJ, Brown RA, Patel R, Razonable RR. Parvovirus B19 infection after transplantation: a review of 98 cases. Clin Infect Dis 2006; 43 (1) 40-48
• 6 Waldman M, Kopp JB. Parvovirus-B19-associated complications in renal transplant recipients. Nat Clin Pract Nephrol 2007; 3 (10) 540-550
• 7 Sturm I, Watschinger B, Geissler K , et al. Chronic parvovirus B19 infection-associated pure red cell anaemia in a kidney transplant recipient. Nephrol Dial Transplant 1996; 11 (7) 1367-1370
• 8 Egbuna O, Zand MS, Arbini A, Menegus M, Taylor J. A cluster of parvovirus B19 infections in renal transplant recipients: a prospective case series and review of the literature. Am J Transplant 2006; 6 (1) 225-231
• 9 Geetha D, Zachary JB, Baldado HM, Kronz JD, Kraus ES. Pure red cell aplasia caused by Parvovirus B19 infection in solid organ transplant recipients: a case report and review of literature. Clin Transplant 2000; 14 (6) 586-591
• 10 Kim JM, Jang HR, Kwon CH , et al. Rabbit antithymocyte globulin compared with basiliximab in kidney transplantation: a single-center study. Transplant Proc 2012; 44 (1) 167-170
• 11 Wong TY, Chan PK, Leung CB, Szeto CC, Tam JS, Li PK. Parvovirus B19 infection causing red cell aplasia in renal transplantation on tacrolimus. Am J Kidney Dis 1999; 34 (6) 1132-1136
• 12 Barzon L, Murer L, Pacenti M , et al. Investigation of intrarenal viral infections in kidney transplant recipients unveils an association between parvovirus B19 and chronic allograft injury. J Infect Dis 2009; 199 (3) 372-380
• 13 Bruu AL, Nordbø SA. Evaluation of five commercial tests for detection of immunoglobulin M antibodies to human parvovirus B19. J Clin Microbiol 1995; 33 (5) 1363-1365
• 14 Kurtzman GJ, Ozawa K, Cohen B, Hanson G, Oseas R, Young NS. Chronic bone marrow failure due to persistent B19 parvovirus infection. N Engl J Med 1987; 317 (5) 287-294
• 15 Manaresi E, Gallinella G, Zuffi E, Bonvicini F, Zerbini M, Musiani M. Diagnosis and quantitative evaluation of parvovirus B19 infections by real-time PCR in the clinical laboratory. J Med Virol 2002; 67 (2) 275-281
• 16 Cassinotti P, Siegl G. Quantitative evidence for persistence of human parvovirus B19 DNA in an immunocompetent individual. Eur J Clin Microbiol Infect Dis 2000; 19 (11) 886-887
• 17 Ardalan MR, Shoja MM, Tubbs RS, Esmaili H, Keyvani H. Postrenal transplant hemophagocytic lymphohistiocytosis and thrombotic microangiopathy associated with parvovirus b19 infection. Am J Transplant 2008; 8 (6) 1340-1344
• 18 Barsoum NR, Bunnapradist S, Mougdil A, Toyoda M, Vo A, Jordan SC. Treatment of parvovirus B-19 (PV B-19) infection allows for successful kidney transplantation without disease recurrence. Am J Transplant 2002; 2 (5) 425-428
• 19 Zolnourian ZR, Curran MD, Rima BK, Coyle PV, O'Neill HJ, Middleton D. Parvovirus B19 in kidney transplant patients. Transplantation 2000; 69 (10) 2198-2202
• 20 Cavallo R, Merlino C, Re D , et al. B19 virus infection in renal transplant recipients. J Clin Virol 2003; 26 (3) 361-368
• 21 Liefeldt L, Buhl M, Schweickert B , et al. Eradication of parvovirus B19 infection after renal transplantation requires reduction of immunosuppression and high-dose immunoglobulin therapy. Nephrol Dial Transplant 2002; 17 (10) 1840-1842
• 22 Eid AJ, Posfay-Barbe KM ; AST Infectious Diseases Community of Practice. Parvovirus B19 in solid organ transplant recipients. Am J Transplant 2009; 9 (4) (Suppl. 04) S147-S150