Abstract: PO2108
Late Presentation of JC Virus-Associated Nephropathy in a Renal Transplant Recipient
Session Information
- Transplantation: Clinical - Allocation, Evaluation, Prognosis, and Viral Onslaughts
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Ghandour, Mohamedanwar M., Wayne State University, Detroit, Michigan, United States
- Suleiman, Samah Saad Mohamed Ahmed, Wayne State University, Detroit, Michigan, United States
- Rossi, Noreen F., Wayne State University, Detroit, Michigan, United States
- Zachariah, Mareena, Wayne State University, Detroit, Michigan, United States
Introduction
JC virus (JCV) is a Polyomaviridae family member.JC virus-associated nephropathy (JCVAN) is more common in renal transplant recipients in comparison to other organ recipients. We report a case of JCVAN presenting after fourteen years post-renal transplantation.
Case Description
A 65-year-old female with primary kidney disease attributed to chronic hypertension, who received a preemptive renal transplant in 2006. Postoperatively, her hospital course was uneventful, with a baseline creatinine of 1.1 mg/dL at discharge. Induction immunotherapy consisted of anti-thymocyte globulin, maintenance immunosuppression (IS) regimen consisted of triple immunotherapy with mycophenolate mofetil, tacrolimus, and low dose prednisone. Approximately 14 years after renal transplant, the patient's renal function deteriorated with creatinine increasing from 1.55 mg/dL to 2.43 mg/dL. The patient underwent a renal biopsy, which revealed positive staining for SV40 in multiple tubular nuclei suggestive of a persistent polyomavirus in the renal tubules (Fig 1). Plasma levels of BK virus were negative. Plasma JC virus titers were 61,400 copies/mL. Mycophenolate was stopped, and tacrolimus was reduced to trough level 3-5ng/dl. JC Viremia responded to lowering IS and became negative. The allograft function declined and the patient returned to dialysis in less than a year.
Discussion
JCVAN is unusual in renal transplant recipients. Risk factors include previous acute rejection episodes and male gender. Notably, this female patient had no proven previous episodes of acute rejection. JCVAN usually occurs within the first year post-renal transplant. However, the reported case was an older female diagnosed with JCVAN fourteen years following the living donor kidney transplant. The diagnosis of JCVAN is confirmed histologically by obtaining a kidney biopsy and the mainstay of management is reducing the degree of immunosuppression.