Polyoma XXXX in renal transplantation: the role of immunosuppressive therapy.

@entity1 @entity778 @entity1901 @entity281 @entity1800 @entity205 @entity618 @entity1986 @entity1011 @entity1140
BACKGROUND: Polyoma @entity778 in renal transplant recipients has been observed with increasing frequency in recent years. Renal allograft involvement in this condition may occur as a result of @entity281 or secondary to reactivation of the latent virus. @entity1986 , @entity1901 , rise in serum @entity1011 and allograft function loss have been attributed to this @entity1800 . METHODS: In this study we reviewed our experience with 8 @entity1 who developed polyoma @entity1800 confirmed by allograft biopsy. All @entity1 were receiving @entity618 as part of the immunosuppression and 7 of the 8 @entity1 were on @entity1140 . All @entity1 have biopsy proven polyoma @entity1800 . The following therapeutic maneuvers were carried out following the diagnosis of polyoma @entity1800 : 1) stopping mycophenolate and 2) switching @entity1140 to @entity205 or reducing the @entity1140 dose to adjust it at a lower therapeutic trough level. The clinical course and outcome of our @entity1 were reviewed in relation to manipulation of immunosuppressive medications. RESULTS: The incidence of this infection in our transplant program in the last 3 yr was 5.3%. Seventy-five percent of the @entity1 had at least one rejection episode and 63% had more than one rejection episode. The main risk factor for the development of polyoma @entity1800 was related to the intensity of immunosuppression. The use of antirejection therapy after histological diagnosis of @entity778 was not associated with improvement of renal function despite the histological appearance of acute rejection. Thus, the @entity1986 associated with polyoma @entity1800 appears to be an inflammatory response to the virus rather than acute rejection. Six out of the 8 @entity1 stabilized renal function with reduction in immunosuppression. CONCLUSIONS: Reduction in immunosuppression was associated with the stabilization of renal function when instituted early. However, these @entity1 were left with a degree of allograft dysfunction and their outcome may be significantly compromised. The lack of effective antiviral therapy for polyoma virus may limit the use of newer and more potent immunosuppressive medications.
