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Pediatric Nephrology

, Volume 33, Issue 12, pp 2343–2352 | Cite as

JC polyomavirus replication and associated disease in pediatric renal transplantation: an international CERTAIN Registry study

  • Britta HöckerEmail author
  • Julia Tabatabai
  • Lukas Schneble
  • Jun Oh
  • Florian Thiel
  • Lars Pape
  • Krisztina Rusai
  • Rezan Topaloglu
  • Birgitta Kranz
  • Günter Klaus
  • Nikoleta Printza
  • Onder Yavascan
  • Alexander Fichtner
  • Kai Krupka
  • Thomas Bruckner
  • Rüdiger Waldherr
  • Michael Pawlita
  • Paul Schnitzler
  • Hans H. Hirsch
  • Burkhard Tönshoff
Original Article
Part of the following topical collections:
  1. What’s New in Renal Transplantation

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.

Keywords

JC polyomavirus JC virus Polyomavirus Nephropathy Pediatric renal transplantation Pediatric kidney transplantation 

Notes

Acknowledgements

The authors wish to thank study nurse Annette Mechler for her continuous excellent contributions to the CERTAIN Registry. BH is an awardee of the “DZIF Clinical Leave Stipend” from the German Center for Infection Research (DZIF).

Author contributions

BH: study design, data collection and analysis, preparation of manuscript, principal investigator. JT and LS: study design, data collection and analysis. JO, FT, LP, KR, RT, BK, GK, NP, OY, JT, AF, and KK: data collection. TB: statistical analysis. RW: histopathological evaluation. MP and PS: virological methodology and analyses, data collection. HHH: study design, preparation of the manuscript. BT: study design, data analyses, preparation of manuscript.

Funding information

The authors acknowledge their gratitude to the Dietmar Hopp Stiftung as well as to the pharmaceutical companies Astellas, Novartis, and Roche for their grants in support of the CERTAIN Registry.

Compliance with ethical standards

Conflict of interests

B.H. received travel grants and participated in advisory boards of Astellas, Novartis, and Roche. H.H.H. reported consultant and speaker honoraria by Novartis, and Chimerix. B.T. received research grants, travel grants, lecture fees, and participated in advisory boards of Astellas, Bristol-Myers Squibb, Novartis, and Roche. J.T., L.S., J.O., F.T., L.P., K.R., R.T. B.K., G.K. N.P., O.Y., A.F., K.K., T.B., R.W., M.P., and P.S. declare no conflict of interests.

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Copyright information

© IPNA 2018

Authors and Affiliations

  • Britta Höcker
    • 1
    Email author
  • Julia Tabatabai
    • 1
    • 2
    • 3
  • Lukas Schneble
    • 1
  • Jun Oh
    • 4
  • Florian Thiel
    • 4
  • Lars Pape
    • 5
  • Krisztina Rusai
    • 6
  • Rezan Topaloglu
    • 7
  • Birgitta Kranz
    • 8
  • Günter Klaus
    • 9
  • Nikoleta Printza
    • 10
  • Onder Yavascan
    • 11
  • Alexander Fichtner
    • 1
  • Kai Krupka
    • 1
  • Thomas Bruckner
    • 12
  • Rüdiger Waldherr
    • 13
  • Michael Pawlita
    • 14
  • Paul Schnitzler
    • 3
  • Hans H. Hirsch
    • 15
    • 16
  • Burkhard Tönshoff
    • 1
  1. 1.Department of Pediatrics IUniversity Children’s HospitalHeidelbergGermany
  2. 2.German Center for Infection ResearchUniversity Hospital HeidelbergHeidelbergGermany
  3. 3.Department of Infectious Diseases, VirologyUniversity Hospital HeidelbergHeidelbergGermany
  4. 4.Department of Pediatric NephrologyUniversity Children’s HospitalHamburgGermany
  5. 5.Hanover Medical SchoolHanoverGermany
  6. 6.Department of Pediatrics and Adolescent MedicineMedical University ViennaViennaAustria
  7. 7.Faculty of Medicine, Department of Pediatric NephrologyHacettepe UniversityAnkaraTurkey
  8. 8.Department of General PediatricsUniversity Children’s Hospital MünsterMünsterGermany
  9. 9.Department of Pediatric NephrologyUniversity Children’s Hospital MarburgMarburgGermany
  10. 10.1st Pediatric DepartmentAristotle University of ThessalonikiThessalonikiGreece
  11. 11.Department of Pediatric NephrologyTepecik Teaching and Research HospitalİzmirTurkey
  12. 12.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany
  13. 13.Institute of PathologyUniversity Hospital HeidelbergHeidelbergGermany
  14. 14.Division of Molecular Diagnostics of Oncogenic InfectionsGerman Cancer Research CenterHeidelbergGermany
  15. 15.Transplantation & Clinical Virology, Department BiomedicineUniversity of BaselBaselSwitzerland
  16. 16.Infectious Diseases & Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland

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