Influence of surveillance renal allograft biopsy on diagnosis and prognosis of polyomavirus-associated nephropathy

Christopher K. Buehrig, Donna J. Lager, Mark D Stegall, Michelle A. Kreps, Walter K Kremers, James M. Gloor, Thomas R. Schwab, Jorge A. Velosa, Mary E. Fidler, Timothy S. Larson, Matthew D. Griffin

Research output: Contribution to journalArticle

152 Citations (Scopus)

Abstract

Background. Polyomavirus-associated nephropathy (PVAN) is an increasingly prevalent cause of allograft dysfunction. Methods. In 18 histologically proven cases of PVAN managed by reduced immunosuppression, monitoring of serum creatinine, and repeated biopsy, graft outcomes were correlated with clinical and histologic indices. Six months postdiagnosis the status of each graft was classified as poor (N = 7) or satisfactory (N = 11). Poor transplant status was defined as graft loss, increased severity of PVAN on repeat biopsy, or serum creatinine >3.0 mg/dL. Diagnosis resulted from either surveillance allograft biopsies (N = 8) or biopsies performed for increased serum creatinine (nonsurveillance, N = 10). Results. The surveillance biopsy group was more likely than the nonsurveillance group to have satisfactory graft status at 6 months (eight of eight vs. three of ten, P = 0.004) and had significantly lower serum creatinine at diagnosis, 3, and 6 months. Histologic scoring for chronic interstitial and tubular injury was lower in diagnostic surveillance biopsies compared to non-surveillance biopsies (P = 0.01). Satisfactory transplant status was also associated with reduced or absent virus on repeat biopsy (P = 0.01). Poor transplant status was associated with a higher frequency of recipientneg/donorpos cytomegalovirus (CMV) serology (71% vs. 9%, P = 0.01). Conclusion. Surveillance allograft biopsy provides an important means for earlier detection of PVAN and permits timely alterations to immunosuppression. Early diagnosis is associated with a lesser degree of interstitial fibrosis at diagnosis and lower baseline and subsequent serum creatinine.

Original languageEnglish (US)
Pages (from-to)665-673
Number of pages9
JournalKidney International
Volume64
Issue number2
DOIs
StatePublished - Aug 1 2003

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Polyomavirus
Allografts
Kidney
Biopsy
Transplants
Creatinine
Serum
Immunosuppression
Serology
Cytomegalovirus
Early Diagnosis
Fibrosis
Viruses

Keywords

  • Acute rejection
  • Histology
  • Immunosuppression
  • Interstitial nephritis
  • Polyomavirus
  • Renal transplantation

ASJC Scopus subject areas

  • Nephrology

Cite this

Influence of surveillance renal allograft biopsy on diagnosis and prognosis of polyomavirus-associated nephropathy. / Buehrig, Christopher K.; Lager, Donna J.; Stegall, Mark D; Kreps, Michelle A.; Kremers, Walter K; Gloor, James M.; Schwab, Thomas R.; Velosa, Jorge A.; Fidler, Mary E.; Larson, Timothy S.; Griffin, Matthew D.

In: Kidney International, Vol. 64, No. 2, 01.08.2003, p. 665-673.

Research output: Contribution to journalArticle

Buehrig, CK, Lager, DJ, Stegall, MD, Kreps, MA, Kremers, WK, Gloor, JM, Schwab, TR, Velosa, JA, Fidler, ME, Larson, TS & Griffin, MD 2003, 'Influence of surveillance renal allograft biopsy on diagnosis and prognosis of polyomavirus-associated nephropathy', Kidney International, vol. 64, no. 2, pp. 665-673. https://doi.org/10.1046/j.1523-1755.2003.00103.x
Buehrig, Christopher K. ; Lager, Donna J. ; Stegall, Mark D ; Kreps, Michelle A. ; Kremers, Walter K ; Gloor, James M. ; Schwab, Thomas R. ; Velosa, Jorge A. ; Fidler, Mary E. ; Larson, Timothy S. ; Griffin, Matthew D. / Influence of surveillance renal allograft biopsy on diagnosis and prognosis of polyomavirus-associated nephropathy. In: Kidney International. 2003 ; Vol. 64, No. 2. pp. 665-673.
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abstract = "Background. Polyomavirus-associated nephropathy (PVAN) is an increasingly prevalent cause of allograft dysfunction. Methods. In 18 histologically proven cases of PVAN managed by reduced immunosuppression, monitoring of serum creatinine, and repeated biopsy, graft outcomes were correlated with clinical and histologic indices. Six months postdiagnosis the status of each graft was classified as poor (N = 7) or satisfactory (N = 11). Poor transplant status was defined as graft loss, increased severity of PVAN on repeat biopsy, or serum creatinine >3.0 mg/dL. Diagnosis resulted from either surveillance allograft biopsies (N = 8) or biopsies performed for increased serum creatinine (nonsurveillance, N = 10). Results. The surveillance biopsy group was more likely than the nonsurveillance group to have satisfactory graft status at 6 months (eight of eight vs. three of ten, P = 0.004) and had significantly lower serum creatinine at diagnosis, 3, and 6 months. Histologic scoring for chronic interstitial and tubular injury was lower in diagnostic surveillance biopsies compared to non-surveillance biopsies (P = 0.01). Satisfactory transplant status was also associated with reduced or absent virus on repeat biopsy (P = 0.01). Poor transplant status was associated with a higher frequency of recipientneg/donorpos cytomegalovirus (CMV) serology (71{\%} vs. 9{\%}, P = 0.01). Conclusion. Surveillance allograft biopsy provides an important means for earlier detection of PVAN and permits timely alterations to immunosuppression. Early diagnosis is associated with a lesser degree of interstitial fibrosis at diagnosis and lower baseline and subsequent serum creatinine.",
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T1 - Influence of surveillance renal allograft biopsy on diagnosis and prognosis of polyomavirus-associated nephropathy

AU - Buehrig, Christopher K.

AU - Lager, Donna J.

AU - Stegall, Mark D

AU - Kreps, Michelle A.

AU - Kremers, Walter K

AU - Gloor, James M.

AU - Schwab, Thomas R.

AU - Velosa, Jorge A.

AU - Fidler, Mary E.

AU - Larson, Timothy S.

AU - Griffin, Matthew D.

PY - 2003/8/1

Y1 - 2003/8/1

N2 - Background. Polyomavirus-associated nephropathy (PVAN) is an increasingly prevalent cause of allograft dysfunction. Methods. In 18 histologically proven cases of PVAN managed by reduced immunosuppression, monitoring of serum creatinine, and repeated biopsy, graft outcomes were correlated with clinical and histologic indices. Six months postdiagnosis the status of each graft was classified as poor (N = 7) or satisfactory (N = 11). Poor transplant status was defined as graft loss, increased severity of PVAN on repeat biopsy, or serum creatinine >3.0 mg/dL. Diagnosis resulted from either surveillance allograft biopsies (N = 8) or biopsies performed for increased serum creatinine (nonsurveillance, N = 10). Results. The surveillance biopsy group was more likely than the nonsurveillance group to have satisfactory graft status at 6 months (eight of eight vs. three of ten, P = 0.004) and had significantly lower serum creatinine at diagnosis, 3, and 6 months. Histologic scoring for chronic interstitial and tubular injury was lower in diagnostic surveillance biopsies compared to non-surveillance biopsies (P = 0.01). Satisfactory transplant status was also associated with reduced or absent virus on repeat biopsy (P = 0.01). Poor transplant status was associated with a higher frequency of recipientneg/donorpos cytomegalovirus (CMV) serology (71% vs. 9%, P = 0.01). Conclusion. Surveillance allograft biopsy provides an important means for earlier detection of PVAN and permits timely alterations to immunosuppression. Early diagnosis is associated with a lesser degree of interstitial fibrosis at diagnosis and lower baseline and subsequent serum creatinine.

AB - Background. Polyomavirus-associated nephropathy (PVAN) is an increasingly prevalent cause of allograft dysfunction. Methods. In 18 histologically proven cases of PVAN managed by reduced immunosuppression, monitoring of serum creatinine, and repeated biopsy, graft outcomes were correlated with clinical and histologic indices. Six months postdiagnosis the status of each graft was classified as poor (N = 7) or satisfactory (N = 11). Poor transplant status was defined as graft loss, increased severity of PVAN on repeat biopsy, or serum creatinine >3.0 mg/dL. Diagnosis resulted from either surveillance allograft biopsies (N = 8) or biopsies performed for increased serum creatinine (nonsurveillance, N = 10). Results. The surveillance biopsy group was more likely than the nonsurveillance group to have satisfactory graft status at 6 months (eight of eight vs. three of ten, P = 0.004) and had significantly lower serum creatinine at diagnosis, 3, and 6 months. Histologic scoring for chronic interstitial and tubular injury was lower in diagnostic surveillance biopsies compared to non-surveillance biopsies (P = 0.01). Satisfactory transplant status was also associated with reduced or absent virus on repeat biopsy (P = 0.01). Poor transplant status was associated with a higher frequency of recipientneg/donorpos cytomegalovirus (CMV) serology (71% vs. 9%, P = 0.01). Conclusion. Surveillance allograft biopsy provides an important means for earlier detection of PVAN and permits timely alterations to immunosuppression. Early diagnosis is associated with a lesser degree of interstitial fibrosis at diagnosis and lower baseline and subsequent serum creatinine.

KW - Acute rejection

KW - Histology

KW - Immunosuppression

KW - Interstitial nephritis

KW - Polyomavirus

KW - Renal transplantation

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