Abstract: PUB363
Late-Onset JC-Polyomavirus-Associated Nephritis in a Kidney Transplant Recipient
Session Information
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Watchmaker, Maxwell C, Washington University in St Louis, St. Louis, Missouri, United States
- Kumar, Shaurya, Fortis Escorts Heart Institute and Research Centre, New Delhi, DL, India
- Lewis, Ian Z., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Vasudev, Brahm S., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction
JC Polyomavirus-Associated Nephritis (JC-PVAN) is a rare complication in kidney transplant recipients from reactivation of the latent JC virus. JC virus is a non-enveloped, double-stranded DNA virus in the Polyomaviridae family. Immunosuppressed patients are at risk of viral reactivation as opposed to asymptomatic primary infection. JC virus may lead to allograft dysfunction, progressive multifocal leukoencephalopathy (PML), and JC viral encephalitis in kidney transplant recipients. We present an atypical case of JC virus manifesting several years post-transplant.
Case Description
A 61-year-old African American female 7 years post deceased donor renal transplant presented with an elevated serum creatinine level of 1.7 mg/dL following years of stable graft function. She had received Alemtuzumab for induction therapy, with maintenance Tacrolimus (4-7 ng/dl), Mycophenolate Mofetil, and Prednisone. After three separate negative BK viral tests with no proteinuria, the JC viral load returned positive.
The patient’s immunosuppression was adjusted from Tacrolimus to Rapamune to enable host defense against JC virus reactivation. The viral load declined from 81,600 copies/mL to 74 copies/mL over a six-year period, without further complications
Discussion
This case illustrates that JC nephritis can be a late cause of allograft dysfunction in kidney transplant recipients. Renal biopsy may show positive SV-40 staining with negative plasma BK NAAT. Reduction in immunosuppression may lead to a significant reduction in viral load, and can prevent further complications such as JC viral encephalitis and PML.
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9799239/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3569895/