Britta Höcker1, Julia Tabatabai2,3,4, Lukas Schneble2, Jun Oh5, Florian Thiel5, Lars Pape6, Krisztina Rusai7, Rezan Topaloglu8, Birgitta Kranz9, Günter Klaus10, Nikoleta Printza11, Onder Yavascan12, Alexander Fichtner2, Kai Krupka2, Thomas Bruckner13, Rüdiger Waldherr14, Michael Pawlita15, Paul Schnitzler4, Hans H Hirsch16,17, Burkhard Tönshoff2. 1. Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany. britta.hoecker@med.uni-heidelberg.de. 2. Department of Pediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany. 3. German Center for Infection Research, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany. 4. Department of Infectious Diseases, Virology, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany. 5. Department of Pediatric Nephrology, University Children's Hospital, Martinistr. 52, 20246, Hamburg, Germany. 6. Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany. 7. Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. 8. Faculty of Medicine, Department of Pediatric Nephrology, Hacettepe University, Ankara, Turkey. 9. Department of General Pediatrics, University Children's Hospital Münster, Waldeyerstraße 22, 48149, Münster, Germany. 10. Department of Pediatric Nephrology, University Children's Hospital Marburg, Baldingerstraße, 35043, Marburg, Germany. 11. 1st Pediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece. 12. Department of Pediatric Nephrology, Tepecik Teaching and Research Hospital, 1140/1 Sk No: 1, 35180 Yenisehir, İzmir, Turkey. 13. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany. 14. Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany. 15. Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. 16. Transplantation & Clinical Virology, Department Biomedicine, University of Basel, Petersplatz 10, 4009, Basel, Switzerland. 17. Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
Abstract
BACKGROUND: JC polyomavirus (JCPyV)-associated nephropathy (JCPyVAN) is a severe, but rare complication in adult renal transplant (RTx) recipients. Related data in pediatric patients are scarce. METHODS: Based on the CERTAIN Registry, we therefore performed a multi-center, retrospective study on the JCPyV antibody status, prevalence of JCPyV replication, and its associated disease in 139 pediatric RTx recipients (mean age, 8.5 ± 5.3 years). JCPyV DNA in plasma and/or urine was measured by quantitative PCR at a median time of 3.2 (IQR, 0.3-8.1) years post-transplant. RESULTS: 53.2% of patients were JCPyV-seronegative prior to transplantation; younger age was associated with JCPyV seronegativity. 34/139 (24.5%) patients post-transplant showed active JCPyV replication in either urine (22.0%), plasma (13.4%), or both (7.6%). JCPyV viremia occurred significantly (p < 0.001) more often in patients with viruria (34.6%) than in those without (7.6%), but 7/118 (5.9%) had isolated viremia. High-level viruria (> 107 copies/mL) was found in 29.6% of viruric patients. A higher net state of immunosuppression constituted an independent risk factor for JCPyV replication both in urine and plasma (OR 1.2, p < 0.02). Male patients tended to have a higher risk of JCPyV viremia than females (OR 4.3, p = 0.057). There was one male patient (0.7%) with JCPyVAN 7 years post-transplant, which resolved after reduction of immunosuppressive therapy. No patient exhibited progressive multifocal leukoencephalopathy. CONCLUSIONS: This first multi-center study on JCPyV in pediatric renal transplant recipients shows that JCPyV replication is common (24.5%), with strong immunosuppression being a significant risk factor, but associated nephropathy is rare.
BACKGROUND:JC polyomavirus (JCPyV)-associated nephropathy (JCPyVAN) is a severe, but rare complication in adult renal transplant (RTx) recipients. Related data in pediatric patients are scarce. METHODS: Based on the CERTAIN Registry, we therefore performed a multi-center, retrospective study on the JCPyV antibody status, prevalence of JCPyV replication, and its associated disease in 139 pediatric RTx recipients (mean age, 8.5 ± 5.3 years). JCPyV DNA in plasma and/or urine was measured by quantitative PCR at a median time of 3.2 (IQR, 0.3-8.1) years post-transplant. RESULTS: 53.2% of patients were JCPyV-seronegative prior to transplantation; younger age was associated with JCPyV seronegativity. 34/139 (24.5%) patients post-transplant showed active JCPyV replication in either urine (22.0%), plasma (13.4%), or both (7.6%). JCPyV viremia occurred significantly (p < 0.001) more often in patients with viruria (34.6%) than in those without (7.6%), but 7/118 (5.9%) had isolated viremia. High-level viruria (> 107 copies/mL) was found in 29.6% of viruric patients. A higher net state of immunosuppression constituted an independent risk factor for JCPyV replication both in urine and plasma (OR 1.2, p < 0.02). Male patients tended to have a higher risk of JCPyV viremia than females (OR 4.3, p = 0.057). There was one male patient (0.7%) with JCPyVAN 7 years post-transplant, which resolved after reduction of immunosuppressive therapy. No patient exhibited progressive multifocal leukoencephalopathy. CONCLUSIONS: This first multi-center study on JCPyV in pediatric renal transplant recipients shows that JCPyV replication is common (24.5%), with strong immunosuppression being a significant risk factor, but associated nephropathy is rare.
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