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Polyomavirus Nephropathy: Ten-Year Experience

2017-05Journal article Open access
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dc.contributor.authorCosta, JS
dc.contributor.authorFerreira, E
dc.contributor.authorLeal, R
dc.contributor.authorBota, N
dc.contributor.authorRomãozinho, C
dc.contributor.authorSousa, V
dc.contributor.authorMarinho, C
dc.contributor.authorSantos, L
dc.contributor.authorMacário, F
dc.contributor.authorAlves, R
dc.contributor.authorPratas, J
dc.contributor.authorCampos, M
dc.contributor.authorFigueiredo, A
dc.date.accessioned2020-03-30T14:33:44Z
dc.date.available2020-03-30T14:33:44Z
dc.date.issued2017-05
dc.description.abstractBACKGROUND: Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL). METHODS: Retrospective analysis of 23 biopsies, from patients with CAD and histological evidence of BKVN, conducted over a period of 10 years. Glomerular filtration rate was <30 mL/min in 16 patients at the time of the BKVN diagnosis. RESULTS: BKVN was histologically diagnosed in 23 recipients (19 men, 4 women). All patients were white, with age of 51.2 ± 12.1 years (6 patients, age >60 years), and 22 had a deceased donor. Diabetes affected 4 patients, DGF occurred in 3, cytomegalovirus infection in 2, and AR in 15. All patients were medicated with calcineurin inhibitors (CNI) (95.7% tacrolimus) and corticoids, and 16 also received an antimetabolite. One year after antimetabolite reduction/discontinuation and/or CNI reduction/switching and/or antiviral agents, graft function was decreased in 11 patients, increased/stabilized in 10, and unknown in 2. GL occurred in 9 patients. Older age (hazard ratio, 1.76; 95% confidence interval, 0.94-3.28) and DGF (hazard ratio, 2.60; 95% confidence interval, 0.54-12.64) were the main risk factors for GL. The lower GFR at the time of the BKVN diagnosis was associated with an increased risk of initiation of dialysis. CONCLUSIONS: GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationTransplant Proc. 2017 May;49(4):803-808.pt_PT
dc.identifier.doi10.1016/j.transproceed.2017.01.072pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.4/2281
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.subjectInibidores de Calcineurina/efeitos adversospt_PT
dc.subjectImunossupressãopt_PT
dc.subjectDoenças do Rimpt_PT
dc.subjectTransplantação de Rimpt_PT
dc.titlePolyomavirus Nephropathy: Ten-Year Experiencept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage808pt_PT
oaire.citation.issue4pt_PT
oaire.citation.startPage803-808pt_PT
oaire.citation.titleTransplantation proceedingspt_PT
oaire.citation.volume49pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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