ESPN 51th Annual Meeting

ESPN 2018


 
Parvovirus B19 Infection Transmitted From Same Cadaveric Donor in Two Renal Transplant Recipients
BURCU BULUM 1 METEHAN ÖZEN 2 DIDEM ATAY 3 ALI ÖZER 4 TONGUÇ UTKU YILMAZ 4 ERCÜMENT GÜRLÜLER 4 REMZI EMIROĞLU 4

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY, ACIBADEM MEHMET ALI AYDINLAR UNIVERSITY SCHOOL OF MEDICINE, ATAKENT ACIBADEM HOSPITAL, İSTANBUL, TURKEY.
2- DEPARTMENT OF PEDIATRIC INFECTIOUS DISEASES, ACIBADEM MEHMET ALI AYDINLAR UNIVERSITY SCHOOL OF MEDICINE, ATAKENT ACIBADEM HOSPITAL, İSTANBUL, TURKEY.
3- DEPARTMENT OF PEDIATRIC HEMATOLOGY, ACIBADEM MEHMET ALI AYDINLAR UNIVERSITY SCHOOL OF MEDICINE, ATAKENT ACIBADEM HOSPITAL, İSTANBUL, TURKEY.
4- DEPARTMENT OF TRANSPLANTATION CENTER, ACIBADEM MEHMET ALI AYDINLAR UNIVERSITY SCHOOL OF MEDICINE, ATAKENT ACIBADEM HOSPITAL, İSTANBUL, TURKEY.
 
Introduction:

Parvovirus B19 (PV B19) infection has been reported among patients after renal transplantation (RT) with different clinical presentations. The short time between RT and onset of infection has the characteristic of donor-transmitted disease, but this is often difficult to prove because of recipients or donors are not routinely tested for PV B19 infection.

Material and methods:

Herein we report two pediatric patients with ESRD who recieved renal graft from same cadaveric donor in our center eight months before. They had PV B19 infection at early post-tranplant period with different clinical presentations which is supposed to be transmitted from same cadaveric donor. 

Results:

First patient was an eight year-old girl with atypic hemolytic uremic syndrome had mild elevated creatinine (0,91 mg/dl), nephrotic range proteinuria (123 mg/m2/h) and microscopic hematuria at first month of RT. Her whole blood count, albumin, and compleman C3, C4 levels were normal. Serum CMV, EBV and BKV PCRs were all negative. Doppler ultrasonography revealed increase of paranchima echogenity. After five days her creatinine levels decreased to 0,4 mg/dl. Biopsy showed peritubuler capilleritis. Proteinuria was lasted for 2.5 months. However, anemia (Hb:8,6 g/dl) and leucopenia (1690/Ul) developed without any complaint, after the proteinuria became negative. Feritin and folat levels were normal. Serum PV B19-PCR was 94,000 copy/ml. After reduction of immunosuppressive medication, clinical response was obtained at the 5th month. At last control her Hb was 13,1 g/dl, Creatinine was 0,2 mg/dl and serum PV B19-PCR was 2,340 copy/ml.

Second patient was a 14-year-old girl with juvenile nephronophthisis was admitted with complaints of fatigue, pallor and tachycardia at the first month. Laboratory examinations showed normochromic normocytic anemia (6,2 g/dl), reticulocytopenia, feritin and folat levels were normal. Serum PV B19-PCR was 2,210,000 copy/ml. Immunosuppressive medication was reduced, then she recieved blood transfusions and IVIG therapy. Clinical and laboratory response was obtained at the 2nd month. At last control her hemoglobin was 12,5 g/dl and serum PV B19-PCR was 5,400 copy/ml.

Conclusions:

Our patients had different clinical features of PV B19 infection at the same time after RT which is supposed to be transmitted from same cadaveric donor. PV B19 infection should be considered in the differantial diagnosis of anemia and persistant proteinuria in renal transplant recipients.