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Transplantation Apr 2022Kidney transplantation is the best health option for patients with end-stage kidney disease. Ideally, a kidney transplant would last for the lifetime of each recipient....
Kidney transplantation is the best health option for patients with end-stage kidney disease. Ideally, a kidney transplant would last for the lifetime of each recipient. However, depending on the age of the recipient and details of the kidney transplant, there may be a need for a second, third, fourth, or even more kidney transplants. In this overview, the outcome of multiple kidney transplants for an individual is presented. Key issues include surgical approach and immunologic concerns. Included in the surgical approach is an analysis of transplant nephrectomy, with indications, timing, and immunologic impact. Allograft thrombosis, whether related to donor or recipient factors merits investigation to prevent it from happening again. Other posttransplant events such as rejection, viral illness (polyomavirus hominis type I), recurrent disease (focal segmental glomerulosclerosis), and posttransplant lymphoproliferative disease may lead to the need for retransplantation. The pediatric recipient is especially likely to need a subsequent kidney transplant. Finally, noncompliance/nonadherence can affect both adults and children. Innovative approaches may reduce the need for retransplantation in the future.
Topics: Adult; Child; Graft Rejection; Humans; Kidney; Kidney Transplantation; Reoperation; Tissue Donors
PubMed: 34310100
DOI: 10.1097/TP.0000000000003888 -
Seminars in Hematology Jul 2019Impaired immune reconstitution has been one of the perceived limitations of alternative donor transplantation. However, modern transplantation platforms such as... (Review)
Review
Impaired immune reconstitution has been one of the perceived limitations of alternative donor transplantation. However, modern transplantation platforms such as HLA-haploidentical transplantation with either post-transplantation cyclophosphamide or with anti-thymocyte globulin combined with intense immunosuppression may be associated with robust immune recovery as inferred by low rate of infectious mortality and post-transplantation lymphoproliferative disease. Here, we review the data on immune reconstitution including individual cell subsets, the effect of reconstitution on outcomes, and comparative studies using these commonly utilized T-cell replete HLA-haploidentical platforms. We find robust recovery of neutrophils, natural killer cells, CD8 T-cells, and B-cells, with delayed CD4 T-cell recovery comparable to that after HLA-matched transplantation. In addition, while viral reactivations and infections appear more common after HLA-haploidentical when compared with HLA-matched transplantation, infectious mortality remains low likely due to modern cytomegalovirus monitoring, preemptive treatment, as well as relative frequency of nonlethal viral infections like polyomavirus hominis 1 (BK virus). Higher graft cell doses also appear to be associated with faster recovery without concomitant increases in lethal graft-vs-host disease. Finally, despite rapid numerical return of natural killer cells post-transplant, phenotypically they retain immaturity markers till day 180 or more after transplantation, which suggests an avenue for future research to improve outcomes further.
Topics: Adult; Female; Hematopoietic Stem Cell Transplantation; Humans; Immune Reconstitution; Killer Cells, Natural; Male; Transplantation Conditioning; Transplantation, Haploidentical
PubMed: 31202434
DOI: 10.1053/j.seminhematol.2019.03.005 -
Urology Journal Sep 2015Polyomavirus hominis 1, better known as BK virus (BKV) infection might be a predisposing factor for prostate cancer (PCa). The aim of this study was to compare the...
PURPOSE
Polyomavirus hominis 1, better known as BK virus (BKV) infection might be a predisposing factor for prostate cancer (PCa). The aim of this study was to compare the frequency of BK virus infection in pathological specimens of patients with PCa compared to patients with benign prostatic hyperplasia.
MATERIALS AND METHODS
From July 2011 to June 2012, paraffin-embedded tissue blocks of patients with PCa (60 specimens) and also with benign prostatic hyperplasia (60 specimens) were investigated. After DNA purification, existence of virus nucleic acid was assessed by polymerase chain reaction.
RESULTS
Viral DNA was identified in 9 patients (15%) with benign prostatic hyperplasia (BPH) and 17 patients (28%) with PCa (P = .076). In patients with PCa, viral DNA was observed more often in those with lower total Gleason scores (P = .045).
CONCLUSION
The frequency of BK virus infection in PCa patients was higher than BPH patients. BK virus was more often observed in patients with lower Gleason scores. Less detection of BK virus DNA in overt cancer may prove the activity of the virus which paves the way for tumorigenic transformation at early stages of PCa.
Topics: Aged; Aged, 80 and over; BK Virus; DNA, Viral; Follow-Up Studies; Humans; Incidence; Iran; Male; Middle Aged; Neoplasm Grading; Polymerase Chain Reaction; Polyomavirus Infections; Prostate; Prostatic Hyperplasia; Prostatic Neoplasms; Retrospective Studies; Risk Factors; Tumor Virus Infections
PubMed: 26341765
DOI: No ID Found -
Annals of Agricultural and... 2015Head and neck cancers are the most common cancers worldwide. It is estimated that approximately 90% of all head and neck cancers are represented by squamous cell...
INTRODUCTION
Head and neck cancers are the most common cancers worldwide. It is estimated that approximately 90% of all head and neck cancers are represented by squamous cell carcinoma (SCC). There are many risk factors causing this type of cancer, including environmental factors and lifestyle choices, such as tobacco smoking or abusing alcohol. Other important risk factor include infectious factors.
OBJECTIVE
The aim of this study was to analyze the prevalence of BK and JC virus infections among patients with oral squamous cell carcinoma (OSCC).
MATERIALS AND METHOD
The correlation between BKV infection and OSCC, and correlation between BKV, OSCC, alcohol abuse, tobacco smoking, demographic data, pre-treatment staging, metastases of lymph node evidence, and grading, was analyzed. The study group consisted of 92 patients with squamous cell carcinoma (OSCC), 75 males, and 17 females, aged between 40 - 87 (average 56.8). All the patients underwent surgery and were not subjected to chemotherapy or radiotherapy prior to treatment. The analyzed samples were collected from paraffin sections.
RESULTS
BKV DNA was detected in 18.5% of patients with OSCC. In the control group, BKV DNA was detected in 3.3%. BKV DNA was statistically more frequently detected among patients with squamous carcinoma, compared to the control group (p<0.05).
CONCLUSIONS
The obtained results suggest that the BKV virus may play an important role in the development of oral squamous cell carcinoma.
Topics: Adult; Aged, 80 and over; BK Virus; Carcinoma, Squamous Cell; Female; Humans; JC Virus; Male; Middle Aged; Mouth Neoplasms; Poland; Polyomavirus Infections; Prevalence; Risk Factors; Tumor Virus Infections
PubMed: 25780838
DOI: 10.5604/12321966.1141378 -
Journal of Medical Virology Feb 2010Polyomavirus hominis 1 (BK virus, BKV) is an important pathogen in the field of transplantation medicine. BKV reactivation among renal-transplant recipients could cause...
Polyomavirus hominis 1 (BK virus, BKV) is an important pathogen in the field of transplantation medicine. BKV reactivation among renal-transplant recipients could cause BK associated nephropathy, which has unfavorable prognosis and is a cause for graft rejection. It is not clear why only few transplanted patients develop BK associated nephropathy while most exhibit asymptomatic viruria. One of the possible reasons lies in the mutations of the VP1 gene, encoding the main structural protein, bearing important determinants for the recognition of specific cellular receptors. The change of amino acid sequence could result in altered pathogenicity of BKV. The amplified sequences of BK in this research were from urines of patients with various clinical conditions along with healthy individuals. Nevertheless the sequence analysis which was undertaken did not show correlation between the viral genotype and the clinical condition. It was demonstrated that the most common BKV genotype in Bulgaria is genotype I and that the strains common in Bulgaria (genotypes I and IV) have typical European origin. Most of the sequenced BKV DNA samples (8/10) were correlated with the highest degree of similarity (81%) to the subcluster Ib. A specific place among the samples is taken by Pr-9, amplified from the urine of a pregnant woman that has a different evolutionary origins and might establish the beginning of a new distinct BKV strain.
Topics: BK Virus; Bulgaria; Capsid Proteins; Cluster Analysis; DNA, Viral; Female; Humans; Male; Molecular Epidemiology; Polymorphism, Genetic; Polyomavirus Infections; Pregnancy; Sequence Analysis, DNA; Sequence Homology; Tumor Virus Infections; Urine
PubMed: 20029813
DOI: 10.1002/jmv.21684 -
Acta Radiologica (Stockholm, Sweden :... Dec 2008Over 70% of the general population worldwide is positive for antibodies against polyomavirus hominis type 1 (BKV). Polyomavirus can be reactivated in immunocompromised...
BACKGROUND
Over 70% of the general population worldwide is positive for antibodies against polyomavirus hominis type 1 (BKV). Polyomavirus can be reactivated in immunocompromised patients and thereby induce urogenital tract infection, including cystitis.
PURPOSE
To describe the computed tomography (CT) findings of human polyomavirus-induced cystitis in adult patients after allogeneic hematopoietic stem cell transplantation (allogeneic HCT).
MATERIAL AND METHODS
The study population was a retrospective cohort of 11 consecutive adult patients (eight men, three women; age range 22-59 years, mean 42.9 years) who received allogeneic HCT between December 2003 and December 2007 and were tested positive for urinary BKV infection. All CT scans were evaluated with regard to bladder wall thickness, mucosal enhancement, distinct layering of thickened bladder wall, and presence of intravesical clots, perivesical stranding as well as attenuation values of intravesical urine. Clinical data concerning transplant and conditioning regimen variables and laboratory parameters were correlated with degree and extent of imaging findings.
RESULTS
All patients had clinical signs of cystitis with different degrees of thickening of the urinary bladder wall. Well-delineated urinary bladder layers were present in six patients. Thickening of the urinary bladder wall was continuous in nine of 11 patients. Increased attenuation of intravesical urine was found in seven patients with hemorrhagic cystitis. Four patients had intraluminal clots. Perivesical stranding was not a major CT finding, occurring in a mild fashion in three of 11 patients. The clinical classification of hemorrhagic cystitis did not correlate with the analyzed imaging parameters. Patient outcome was not influenced by this infectious complication.
CONCLUSION
CT findings in patients with polyomavirus BK cystitis consist of different degrees of bladder wall thickening usually with good delineation of all mural layers and increased mucosal enhancement. These findings are not specific for BKV cystitis, but awareness of this differential diagnosis should help in the early diagnosis and correct management of this infectious complication.
Topics: Adult; BK Virus; Cohort Studies; Contrast Media; Cystitis; Diagnosis, Differential; Female; Hematocrit; Hematopoietic Stem Cell Transplantation; Hematuria; Humans; Iohexol; Male; Middle Aged; Observer Variation; Platelet Count; Polyomavirus Infections; Radiographic Image Enhancement; Retrospective Studies; Severity of Illness Index; Tomography, X-Ray Computed; Tumor Virus Infections; Urinary Bladder; Young Adult
PubMed: 18932047
DOI: 10.1080/02841850802454733 -
Journal of Clinical Virology : the... Nov 2008Pregnancy is associated with down-regulation of immune responses of the mother. This might lead to reactivation and vertical transmission of latent viral infections such...
BACKGROUND
Pregnancy is associated with down-regulation of immune responses of the mother. This might lead to reactivation and vertical transmission of latent viral infections such as BK virus (BKV).
OBJECTIVES
To determine the presence of BKV in the urine of pregnant women and in cord blood at delivery.
STUDY DESIGN
We examined urines from 52 pregnant women and 51 cord blood samples for BKV by real-time SYBR green PCR.
RESULTS
BKV DNA was found in the urine of 18 (34.6%) pregnant women. No BKV DNA was detected by SYBR green PCR in the cord blood specimens.
CONCLUSIONS
BKV reactivation is common during pregnancy but this is not associated with BKV in cord blood.
Topics: Adult; BK Virus; DNA, Viral; Female; Fetal Blood; Humans; Infectious Disease Transmission, Vertical; Polymerase Chain Reaction; Polyomavirus Infections; Pregnancy; Pregnancy Complications, Infectious; Tumor Virus Infections; Urine; Virus Activation
PubMed: 18819839
DOI: 10.1016/j.jcv.2008.08.002 -
Clinical Infectious Diseases : An... Aug 2005More than 70% of the general population worldwide has serological evidence of exposure to Polyomavirus hominis type 1, better known as BK virus (BKV). BKV infection... (Review)
Review
More than 70% of the general population worldwide has serological evidence of exposure to Polyomavirus hominis type 1, better known as BK virus (BKV). BKV infection typically occurs during childhood, without specific symptoms, followed by a state of nonreplicative infection in various tissues, with the urogenital tract as the principal site. Asymptomatic reactivation and low-level replication with viruria is observed in 5% of healthy individuals. Persistent high-level BKV replication is the hallmark of polyomavirus-associated nephropathy in renal transplantation and of hemorrhagic cystitis in bone marrow transplantation. Since these manifestations are rare in other types of immunocompromised patients, the presence of specific cofactors is postulated. The role of BKV in autoimmune disease and cancer is a controversial topic and is difficult to determine, because the pathology no longer depends on BKV replication. This article discusses current views of pathogenesis, diagnosis, and treatment.
Topics: BK Virus; Humans; Opportunistic Infections; Polyomavirus Infections; Tumor Virus Infections
PubMed: 16007533
DOI: 10.1086/431488 -
Archives de Pediatrie : Organe Officiel... Apr 2005Polyomavirus hominis 1, better known as BK virus (BKV), infects up to 90% of the general population. Significant clinical manifestations can be seen in immunocompromised...
Polyomavirus hominis 1, better known as BK virus (BKV), infects up to 90% of the general population. Significant clinical manifestations can be seen in immunocompromised patients. We report a case of haemorragic cystitis likely due to BKV in a child after allotransplantation of hematopoietic stem cells. A 10-year old boy with poor-prognosis acute T lymphoblastic leukaemia underwent cord blood allogeneic stem cell transplantation while in his first relapse. Macroscopic haematuria and low back pain occurred by day 95, in the context of acute graft versus host disease and pulmonary aspergillosis. Histopathologic examination showed a cytopathogenetic effect consistent with the diagnosis of BKV infection. Urinary PCR was positive for BKV. Treatment with cidofovir was followed by a marked improvement of urinary symptoms. The current understanding, diagnosis, and treatment of BKV-associated infection is discussed.
Topics: Antiviral Agents; BK Virus; Child; Cidofovir; Cytosine; Hematopoietic Stem Cell Transplantation; Humans; Leukemia-Lymphoma, Adult T-Cell; Male; Organophosphonates; Polyomavirus Infections; Prognosis
PubMed: 15893243
DOI: 10.1016/s0929-693x(05)80016-8 -
The Lancet. Infectious Diseases Oct 2003Polyomavirus hominis 1, better known as BK virus (BKV), infects up to 90% of the general population. However, significant clinical manifestations are rare and limited to... (Review)
Review
Polyomavirus hominis 1, better known as BK virus (BKV), infects up to 90% of the general population. However, significant clinical manifestations are rare and limited to individuals with impaired immune functions. BKV has been associated with diverse entities such as haemorrhagic cystitis, ureteric stenosis, vasculopathy, pneumonitis, encephalitis, retinitis, and even multi-organ failure. In addition, BKV has been implicated in autoimmune disease and possibly cancer. Due to high prevalence and frequent reactivation, the role of BKV in some of these pathologies has been difficult to define. Development of BKV diseases is likely to require complementing determinants in the host, the target organ, and possibly the virus, that are subject to modulators such as immunosuppression. These complex aspects are highlighted in polyomavirus-associated nephropathy (PAN), an emerging disease in renal allograft recipients that may jeopardise the progress in renal transplantation accomplished in the past 10 years. Intervention is difficult due to the lack of specific antivirals and relies mostly on improving immune control. Diagnostic strategies using urine cytology and BKV load measurements in plasma have led to earlier diagnosis of PAN, which increased the success rate of intervention. Case series suggest that cidofovir might be effective, especially when combined with reduced immunosuppression.
Topics: Antiviral Agents; BK Virus; Cidofovir; Cytosine; Humans; Immunocompromised Host; Kidney Diseases; Kidney Transplantation; Organophosphonates; Organophosphorus Compounds; Polyomavirus Infections; Tumor Virus Infections
PubMed: 14522260
DOI: 10.1016/s1473-3099(03)00770-9