Clinical and pathological features of kidney transplant patients with concurrent polyomavirus nephropathy and rejection-associated endarteritis

Table 1 Patient demographics

	Known prior change of IS (n = 4)	No known prior change of IS (n = 3)	All cases (n = 7)
Age, years (range)	55.5 (43-68)	38.7 (15-58)	48.3 (15-68)
Sex, n
Male	4	3	7
Female	0	0	0
Cause of end stage renal disease, n
DM ± HTN	4	1	5
PCKD	0	1	1
CON	0	1	1
No. of HLA matches, average (range)
Class I (HLA-A, HLA-B)	0.25 (0-1)	0	0.14 (0-1)
Class II (HLA-DR)	0.50 (0-2)	0.33 (0-1)	0.43 (0-2)
Donor age, years (range)	38.5 (17-57)	22.0 (18-30)	31.4 (17-57)
Cold ischemia time, hours (range)	22.4 (15.0-37.5)	17.8 (14.1-21.2)	20.4 (14.1-37.5)
Delayed graft function, n	1	0	1
Baseline creatinine, mg/dL (range)	1.4 (1.1-1.8)	1.6 (1.2-1.8)	1.4 (1.1-1.8)
Time of index biopsy, months after	231 (135-317)	507 (45-1293)	349 (45-1293)
transplant (range)
Creatinine at index biopsy, mg/dL	3.3 (1.8-6.2)	1.9 (1.7-2.2)	2.7 (1.7-6.2)
(range)
Donor-specific antibodies prior to	0	0	0
transplant

HLA: Human leukocyte antigen; DM: Diabetes mellitus; HTN: Hypertension; PCKD: Polycystic kidney disease; CON: Congenital obstructive nephropathy; IS: Immunosuppression.

Table 2 Clinical information

	Baseline Cr	Serum Cr at index biopsy (mg/dL)	BKV DNA copies/mL at index biopsy		Maintenance IS	Change of IS after diagnosis of PVN		Antirejection therapy				Antiviral		Creatinine trend (mo; mg/dL)				BK viremia trend (mo; × 103 copies/mL)
			Serum (× 103)	Urine (× 106)		Disc. MMF	Reduced Tacrolimus	Steroids	IVIG	Rapamycin	Thymoglobulin	Arava	Cidofovir	1	3	6	12	3	12	Time to clear
1	1.2	3.4	33002	> 13002	MTP	Yes1	Yes1	Yes	No	No	No	Yes	Yes	1	2	3	3.933	Pos4	Pos4	Not cleared4
2	1.1	1.8	0	1.3	MTP	Yes1	Yes1	No	Yes	No	No	No	Yes	1	3	2	2	0	0	NA
3	1.3	6.2	ND	ND	MTP	Yes1	No	ND	ND	ND	ND	ND	ND	4	ND	3	GL	ND	ND	ND
4	1.8	1.9	0	ND	MTP	Yes1	No	Yes	No	No	Yes	Yes	No	2	3	4	GL	0	0	NA
5	1.8	2.2	2102	> 13002	MTP	Yes	No	No	Yes	No	No	Yes	No	2	2	2	2	< 2.5	0	9
6	1.7	1.7	7	> 25	MTP	Yes	No	Yes	No	No	Yes	Yes	No	2	2	2	1	0	0	2
7	1.2	1.7	1342	17002	STP	NA	Yes	No	No	No	No	Yes	No	2	2	2	1	0.6	0	9

¹Change occurred prior to index biopsy;

²BK viral load performed at outside institution with different reference ranges;

³Subsequent graft loss at 483 d;

⁴Positive, exact viral titers not available. BKV: BK virus; IS: Immunosuppression; PVN: Polyomavirus nephropathy; MMF: Mycophenolate mofetil; IVIG: Intravenous immunoglobulin; MTP: Mycophenolate mofetil, tacrolimus and prednisone; NA: Not applicable; ND: Not determined; GL: Graft loss; STP: Sirolimus, tacrolimus and prednisone.

Table 3 Pathology

Patient ID	AR type	C4d	% SV40-T antigen + tubules	DS	I	T	CI	CT	V	HMX	G	MM	CV	AH	Plasma cells1
1	2A	-	8.4	B3	3	3	1	3	1	1	0	1	2	2	Yes
2	2A	+	0.7	B2	3	1	3	3	1	3	0	0	1	0	No
3	2A	+	8	B2	3	3	1	1	1	1	1	0	0	1	Yes
4	2A	+	0.9	B3	3	3	1	1	1	1	0	0	2	1	Yes
5	2A	-	11.5	B3	1	3	1	1	1	1	0	0	0	1	No
6	2A	-	1.2	B2	1	1	1	1	1	1	1	1	1	0	No
7	2A	-	11.3	B3	3	2	3	3	1	0	1	0	1	1	No

¹Plasma cells comprise > 20% of infiltrate. AR: Acute rejection; DS: Drachenberg stage; HMX: Interstitial hemorrhage; I: Interstitial inflammation; T: Tubulitis; CI: Interstitial fibrosis; CT: Tubular atrophy; V: Arteritis; G: Glomerulitis; MM: Mesangial matrix; CV: Vascular fibrous intimal thickening; AH: Arteriolar hyaline thickening.