ESPN 51th Annual Meeting

ESPN 2018


 
JC Polyomavirus (JCPyV) Replication and Associated Morbidity in Pediatric Renal Transplantation: An International CERTAIN Registry Study
Britta Höcker 1 Julia Tabatabai 1 Lukas Schneble 1 Jun Oh 2 Florian Thiel 2 Lars Pape 2 Krisztina Rusai 2 Rezan Topaloglu 2 Birgitta Kranz 2 Günter Klaus 2 Nikoleta Printza 2 Önder Yavascan 2 Alexander Fichtner 1 Kai Krupka 1 Thomas Bruckner 2 Rüdiger Waldherr 2 Michael Pawlita 2 Paul Schnitzler 2 Hans H. Hirsch 2 Burkhard Tönshoff 1

1- UNIVERSITY CHILDREN^S HOSPITAL OF HEIDELBERG, GERMANY
2- CERTAIN Research Community
 
Introduction:

The JC polyomavirus (JCPyV) is well-known as causative agent for progressive multifocal leukencephalopathy (PML) in immunocompromised individuals. In addition, JCPyV-associated nephropathy (JCPyVAN) is a rare complication in renal transplant recipients, but data in pediatric patients is scarce.

Material and methods:

In the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN), we therefore analyzed the epidemiology and morbidity of JCPyV infection among 139 pediatric kidney allograft recipients (aged 8.5 ± 5.3 years at renal transplantation) in a multicenter retrospective and cross-sectional study. JCPyV viral load in plasma and/or urine was measured by quantitative PCR at a median time of 3.2 years post-transplant (IQR, 0.3 – 8.1 years).

Results:

34/139 (24.5%) patients showed active JCPyV replication. In 118 patients, PCR was performed in both urine and plasma: 26 (22.0%) had JCPyV viruria and 16 (13.4%) JCPyV viremia. JCPyV viremia was diagnosed significantly (p<0.001) more often in patients with viruria (9/26, 34.6%) than in those without (7/92, 7.6%). However, 7/118 (5.9%) developed viremia without concomitant viruria. High-level viruria (> 10^7 copies/ml) was found in 29.6% of viruric patients. A higher net state of immunosuppression was an independent risk factor for JCPyV replication (pediatric Vasudev score; OR 1.2 per unit, p<0.02). Male patients tended to have a higher risk of JCPyV viremia (OR 4.3, p=0.057) than females. One boy (0.7%) developed JCPyVAN seven years post-transplant, which was confirmed by JCPyV PCR and SV40Ag positivity in the transplant biopsy, in the absence of BKPyV replication. After reduction of the immunosuppressive therapy, graft function improved, while JCPyV viruria decreased significantly, and viremia dissolved. No patient developed PML.

Conclusions:

This is the so far largest study on JCPyV in pediatric renal transplant recipients. We conclude that JCPyV replication is common (24.5%), but associated nephropathy (JCPyVAN) is rare (0.7%), with strong immunosuppression being a significant risk factor.