Abstract :
Background: Parvovirus B19 (PVB19) stands as a non-enveloped DNA virus known for its ubiquitous presence as a human pathogen, primarily transmitted via respiratory droplets. It affects immunosuppressed individuals like kidney transplant recipients who present with anaemia which is treatable. A high index of suspicion should be maintained in patients with Anaemia in the post-transplant phase, especially those who have received higher doses of immunosuppressants. Early diagnosis and appropriate intervention can minimize the negative impacts of the infection.
Aim and Objective: To study the clinical outcomes of Parvovirus B19 infection in kidney transplant recipients.
Materials and Methods: This is a single center, retrospective study of clinical outcomes of the Parvovirus B19 infection in kidney transplant recipients over a ten-year period (01 January 2002 to 31 Dec 2022) from a tertiary care hospital in southern India. The clinical data were obtained from electronic medical records of the department of Virology and outpatient department of kidney transplant clinic. The data was entered and results were analysed using SPSS software Ver 22.
Results: A total of 1802 patients underwent renal transplants at the study centre during 01 January 2002 to 31 December 2022. During this period, twelve patients (11 male and 1 female) were diagnosed to have Parvovirus B19 infection. The mean age of these patients was 36.8 12 years. Nine of the 12 patients developed the infection in the first year after renal transplantation with the mean duration of 6.5 3.2 months. Two patients developed infection six years after transplantation and one patient 13 years after transplantation. All these patients presented with refractory anaemia in the post-transplant period with mean haemoglobin concentration of 5.37 0.69 gm/dl. All these patients were similarly managed initially with a reduction of their immunosuppressive drugs but none of them showed response. They were then given 400 mg/kg/day intravenous immunoglobulin (IVIg) which contains protective immunoglobulins from many donors for five consecutive days. Two-thirds of the patients (eight of the twelve) responded to the IVIg while the remaining did not show any response even to a repeat dose of IVIg, they were treated with Inj. Rituximab at the dose of 375 mg/m2 based on assumption that parvovirus infection triggered auto immune hemolytic anaemia in these patients.
Conclusion: PVB19 stands as a significant and treatable cause of post-transplant anaemia in renal allograft recipients. Vigilance for PVB19 infection in anaemic post-transplant patients, particularly those with heightened immunosuppression, is crucial for early intervention and minimizing adverse outcomes. While reduction of immunosuppression and IVIg therapy may suffice for many cases, refractory cases may necessitate innovative approaches like Rituximab, warranting further exploration through randomized controlled trials.
Keyword :
Parvovirus B19, Kidney transplant Recipient, Refractory anaemia, Intravenous Immunoglobulin, Auto immune haemolytic anaemia, Rituximab.