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30.07.2018 | Original Article | Ausgabe 12/2018

Pediatric Nephrology 12/2018

JC polyomavirus replication and associated disease in pediatric renal transplantation: an international CERTAIN Registry study

Zeitschrift:
Pediatric Nephrology > Ausgabe 12/2018
Autoren:
Britta Höcker, Julia Tabatabai, Lukas Schneble, Jun Oh, Florian Thiel, Lars Pape, Krisztina Rusai, Rezan Topaloglu, Birgitta Kranz, Günter Klaus, Nikoleta Printza, Onder Yavascan, Alexander Fichtner, Kai Krupka, Thomas Bruckner, Rüdiger Waldherr, Michael Pawlita, Paul Schnitzler, Hans H. Hirsch, Burkhard Tönshoff
Wichtige Hinweise
Hans H. Hirsch and Burkhard Tönshoff contributed equally to this work.

Abstract

Background

JC polyomavirus (JCPyV)-associated nephropathy (JCPyVAN) is a severe, but rare complication in adult renal transplant (RTx) recipients. Related data in pediatric patients are scarce.

Methods

Based on the CERTAIN Registry, we therefore performed a multi-center, retrospective study on the JCPyV antibody status, prevalence of JCPyV replication, and its associated disease in 139 pediatric RTx recipients (mean age, 8.5 ± 5.3 years). JCPyV DNA in plasma and/or urine was measured by quantitative PCR at a median time of 3.2 (IQR, 0.3–8.1) years post-transplant.

Results

53.2% of patients were JCPyV-seronegative prior to transplantation; younger age was associated with JCPyV seronegativity. 34/139 (24.5%) patients post-transplant showed active JCPyV replication in either urine (22.0%), plasma (13.4%), or both (7.6%). JCPyV viremia occurred significantly (p < 0.001) more often in patients with viruria (34.6%) than in those without (7.6%), but 7/118 (5.9%) had isolated viremia. High-level viruria (> 107 copies/mL) was found in 29.6% of viruric patients. A higher net state of immunosuppression constituted an independent risk factor for JCPyV replication both in urine and plasma (OR 1.2, p < 0.02). Male patients tended to have a higher risk of JCPyV viremia than females (OR 4.3, p = 0.057). There was one male patient (0.7%) with JCPyVAN 7 years post-transplant, which resolved after reduction of immunosuppressive therapy. No patient exhibited progressive multifocal leukoencephalopathy.

Conclusions

This first multi-center study on JCPyV in pediatric renal transplant recipients shows that JCPyV replication is common (24.5%), with strong immunosuppression being a significant risk factor, but associated nephropathy is rare.

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