Clinical Efficacy of Intravenous Immunoglobulin for BK Polyomavirus-Associated Nephropathy After Living Kidney Transplantation

Figures & data

Table 1 Clinical Information of 5 Patients with BKPyVAN

Case	Sex	Age at Tx	Primary Disease	Transplant History	Duration from Dialysis to Tx (Months)	Duration from Tx to Diagnosis of BKPyVAN (Months)	The Number of HLA Mismatch	Donor	ABO	Degree of Relationship	Sex (Donor)	Age (Donor)	Immunosuppressant
1	M	44	ADPKD	None	18.1	12.8	3	LRD	Incompatible	2nd (Sister)	F	52	TAC, MMF, PSL
2	M	43	IgA nephropathy	None	9	11.6	3	LRD	Incompatible	1st (Father)	M	77	TAC, MMF, PSL
3	F	53	IgA nephropathy	None	201.9	7.9	4	LRD	Incompatible	1st (Husband)	M	61	TAC, MMF, PSL
4	F	26	ADTKD	None	2.3	36.4	3	LRD	Compatible	1st (Mother)	F	58	TAC, MMF, PSL
5	M	51	Unknown	Heart transplant	10.7	9.1	2	LRD	Compatible	1st (Mother)	F	80	TAC, MMF, PSL, EVR

Abbreviations: ADTKD, autosomal dominant tubulointerstitial kidney disease; ADPKD, autosomal dominant polycystic kidney disease; BKPyVAN, BK polyomavirus-associated nephropathy; EVE, everolimus; F, female; LRD, living related donor; M, male; MMF, mycophenolate mofetil; PSL, prednisolone; TAC, tacrolimus; Tx, transplantation.

Table 2 Comparison of Decoy Cells in Urine, Plasma BK Viral Load and Pathological Findings at the Time of Pre-Treatment and Post-Treatment with IVIG

Case	At Diagnosis of BKPyVAN					Post Reduction of Immunosuppressants		Post IVIG Treatment
	Decoy Cells in Urine	Plasma BK Viral Load	Pathological Diagnosis			Decoy Cells in Urine	Plasma BK Viral Load	Decoy Cells in Urine	Plasma BK Viral Load	Pathological Diagnosis
			PVN Class	pvl Score	ci Score					PVN Class	pvl Score	ci Score
1	Positive	30,000	Class II	2	1	Positive	10,000	Positive	300	Presumptive PVN		1
2	Positive	8000	Class II	2	1	Positive	70,000	Negative (after 5 months)	< 200	Presumptive PVN		1
3	Positive	5000	Class II	2	2	Positive	200	Negative (after 5 months)	< 200	Class II	1	3
4	Positive	Negative	Class II	2	2	Positive	Negative	Positive	Negative	Presumptive PVN		2
5	Positive	Negative	Class II	2	1	Positive	Negative	Positive	Negative	Presumptive PVN		1

Abbreviation: BKPyVAN, BK polyomavirus-associated nephropathy.

Figure 1 Comparison of representative renal histopathological findings at the time of initial biopsy and repeated biopsy after IVIG therapy. (A) Clinical course of typical case (case 3). (B) SV40 positive cells diminished after IVIG therapy in all cases. (C) Many intranuclear inclusions were observed and lymphocytes infiltrated into the interstitium (A1). After IVIG therapy, the inclusion bodies in the nucleus disappeared. The number of lymphocytes was decreased (A2). A wide range of interstitial fibrosis was observed in the sample of initial diagnosis (B1). The area of interstitial fibrosis improved after IVIG therapy (B2). HE staining for A1 and A2 and Elastica-Masson staining for B1 and B2. Magnification: 100 × for all pictures, 400 × for inset pictures of A1 and A2. Scale bars = 100um.

Abbreviations: BKPyVAN, BK polyomavirus-associated nephropathy; IVIG, intravenous immunoglobulin.