M Zhang1,2,3, X Zhong1,2,3, W Zhang1,2,3, J Xu1,2,3, M Zhang1,2,3, Y Shen1,2,3, W Wang1,2,3, S Zheng1,2,3. 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China. 3. Key Laboratory of Organ Transplantation, Hangzhou, China.
Abstract
AIM: Th aim of this study was to explore the diagnosis and treatment of pure red cell aplasia (PRCA) induced by human parvovirus B19 (HPV B19) infection in liver transplant recipients. METHODS: We described and analysed the clinical manifestation, diagnosis, treatment and prognosis of the 13 liver transplant recipients confirmed to have PRCA induced by HPV B19. RESULTS: In the past 3 years, 13 liver transplant recipients out of a cohort of 570 recipients were confirmed to have PRCA induced by HPV B19. Some experienced fever (eight patients) but all of the patients had a gradual decline of haemoglobin levels within 2 months posttransplantation. The diagnosis was confirmed by several tests including bone marrow aspiration and polymerase chain reaction (PCR) assays. All recipients achieved remission using symptomatic treatment that included intravenous immunoglobulins (IVIG), immunosuppressive regimen switch and blood transfusion. CONCLUSION: Pure red cell aplasia induced by HPV B19 infection is a disease with a favourable prognosis after symptomatic and supportive treatment. (i) Pure red cell aplasia anaemia is a prominent clinical sign of HPV B19 infection in liver transplant recipients. (ii) PCR technology combined with bone marrow aspiration and other laboratory examinations will meet the requirement for the diagnosis and suggests that the differential diagnosis includes PRCA and graft versus host disease (GVHD). (iii) IVIG is recommended as the first regimen for the treatment of PRCA induced by HPV B19 infection in liver transplant recipients. IVIG can be repeated if the patient has a relapse. (iv) A switch of the baseline immunosuppressive regimen may achieve a favourable curative effect.
AIM: Th aim of this study was to explore the diagnosis and treatment of pure red cell aplasia (PRCA) induced by human parvovirus B19 (HPV B19) infection in liver transplant recipients. METHODS: We described and analysed the clinical manifestation, diagnosis, treatment and prognosis of the 13 liver transplant recipients confirmed to have PRCA induced by HPV B19. RESULTS: In the past 3 years, 13 liver transplant recipients out of a cohort of 570 recipients were confirmed to have PRCA induced by HPV B19. Some experienced fever (eight patients) but all of the patients had a gradual decline of haemoglobin levels within 2 months posttransplantation. The diagnosis was confirmed by several tests including bone marrow aspiration and polymerase chain reaction (PCR) assays. All recipients achieved remission using symptomatic treatment that included intravenous immunoglobulins (IVIG), immunosuppressive regimen switch and blood transfusion. CONCLUSION: Pure red cell aplasia induced by HPV B19 infection is a disease with a favourable prognosis after symptomatic and supportive treatment. (i) Pure red cell aplasia anaemia is a prominent clinical sign of HPV B19 infection in liver transplant recipients. (ii) PCR technology combined with bone marrow aspiration and other laboratory examinations will meet the requirement for the diagnosis and suggests that the differential diagnosis includes PRCA and graft versus host disease (GVHD). (iii) IVIG is recommended as the first regimen for the treatment of PRCA induced by HPV B19 infection in liver transplant recipients. IVIG can be repeated if the patient has a relapse. (iv) A switch of the baseline immunosuppressive regimen may achieve a favourable curative effect.