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Immunologic control for polyomavirus infection after kidney transplantation

Authors
 Hyung Joon Ahn  ;  Man Ki Ju  ;  Hyeon Joo Jeong  ;  Myoung Soo Kim  ;  Hyon Suk Kim  ;  Kyu Ha Huh  ;  Jong Hoon Lee  ;  Soon Il Kim  ;  Yu Seun Kim 
Citation
 NEPHRON, Vol.108(2) : 148-154, 2008 
Journal Title
 NEPHRON 
ISSN
 1660-8151 
Issue Date
2008
MeSH
Age Distribution ; Aged ; Female ; Follow-Up Studies ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppressive Agents/therapeutic use* ; Incidence ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/surgery* ; Kidney Transplantation/adverse effects ; Kidney Transplantation/immunology* ; Kidney Transplantation/mortality ; Male ; Middle Aged ; Monitoring, Physiologic/methods ; Polymerase Chain Reaction ; Polyomavirus/isolation & purification* ; Polyomavirus Infections/diagnosis* ; Polyomavirus Infections/epidemiology ; Polyomavirus Infections/urine ; Postoperative Complications ; Prospective Studies ; RNA, Viral/analysis ; Risk Assessment ; Severity of Illness Index ; Sex Distribution ; Statistics, Nonparametric ; Transplantation Immunology
Keywords
Polyomavirus infection ; Urine decoy cell ; Polymerase chain reaction ; Kidney transplantation
Abstract
Aims: We compared the relative efficacy of urine decoy cell (UDC) and polymerase chain reaction (PCR) to identify polyomavirus (PV) infection, and investigate the efficacy of reduction of immunosuppression for earlier-stage PV infection before irreversible graft injury. Methods: A total of 222 de novo renal transplant recipients from March 2003 to September 2005 were enrolled. Prospective UDC monitoring with supplementary PV-PCR was performed. Early reduction of immunosuppression was guided by the results of UDC and PV-PCR. Results: The positive predictive value of urine cytology for PV infection was 48.8%, and the negative predictive value was 74.1%. After reduction of immunosuppression, negative conversion or significant decrease of viral titer was achieved 100% in 15 PV-PCR positive recipients. Only 3 patients who were neglected or overlooked for PV screening or positive test results early after transplantation were diagnosed as having PV nephropathy, and resulted in graft dysfunction and failure. From January 2001 to December 2002, when we did not monitor the PV infection, there were 7 cases of PV nephropathy among 116 recipients. Conclusion: The combination of UDC and PV-PCR should be considered for screening of PV infection. Reduction of immunosuppression based on UDC monitoring and PV viral loads may reduce the incidence of PV nephropathy.
Full Text
http://www.karger.com/Article/FullText/115327
DOI
10.1159/000115327
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Kim, Hyon Suk(김현숙) ORCID logo https://orcid.org/0000-0001-5662-7740
Ahn, Hyung Joon(안형준)
Lee, Jong Hoon(이종훈)
Jeong, Hyeon Joo(정현주) ORCID logo https://orcid.org/0000-0002-9695-1227
Joo, Man Ki(주만기) ORCID logo https://orcid.org/0000-0002-4112-7003
Huh, Kyu Ha(허규하) ORCID logo https://orcid.org/0000-0003-1364-6989
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/106268
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