Clinical Study Of Parvovirus B19 Infection After Renal Transplantation

Part ?:Epidemiology and risk factors of parvovirus B19infection after renal transplantationObjective:To investigate the epidemiological characteristics and risk factors of parvovirus B19 infection after renal transplantation.Methods:Clinical data of patients undergoing allogeneic renal transplantation in Center for Transplantation of Shanghai Changhai Hospital from March 1,2016 to December 31,2019 were reviewed,and the patients with parvovirus B19 infection confirmed by quantitative polym erase chain reaction were screened retrospectively.The epidemiological characteristics were summarized.Two times the number of uninfected patients were selected and clinical data differences were compared.Logistic regression was applied to analyze the risk factors of parvovirus B19 infection after renal transplantation.Results:Twenty-seven cases of parvovirus B19 infection after renal transplantation were collected,with an overall incidence rate of 3.54%.The incidence rate of pediatric recipients was higher than that of adult s(P=0.043).The median diagnostic time was 35(13?572)days after transplantation,and the onset time was distributed throughout the year,without seasonal concentration.There were no transfusion-transmitted infections,but infections transmitted from plasma derivatives were confirmed in two cases.Salivary parvovirus B19 DNA was higher than 10~4copies/ml within 4 weeks after diagnosis.The univariate analysis showed that there were significant differences in induction regimen,plasma derivatives injection,EPO and surgical complications between the two groups(P<0.05).In multivariate regression analysis,plasma derivatives injection after renal transplantation showed significant correlations with parvovirus B19 infection(OR=20.647,95%CI=2.422?176.028,P=0.006).Conclusions:Parvovirus B19 infection after renal transplantation is predominant immediately after renal transplantation,without seasonal concentration.The incidence rate was higher and the onset time was earlier in pediatric recipients than adults.There were plasma derivatives injection transmitted infections.Period of droplet transmission may be as long as one month.Plasma derivatives injection may be a risk factor for parvovirus B19infection after renal transp lantation.Part ?:Diagnosis and treatment of parvovirus B19infection after renal transplantationObjective:To summarize the diagnosis and treatment strategies of parvovirus B19 infection after renal transplantation.Methods:Clinical data of patients with parvovirus B19 infection after renal transplantation in Center for Transplantation of Shanghai Changhai Hospital from March 1,2016 to December 31,2019 were collected retrospectively.Clinical manifestations,methods of early diagnosis and treatment,long-term prognosis were summarized and analyzed.Results:1.Clinical manifestations:All patients had varying degrees of anemia;the incidences of low fever,joint pain and rash were 33.3%(9 cases),7.4%(2 cases)and 0,respectively.2.Laborator y examinations:The average hemoglobin at diagnosis was(67.0±11.5)g/L,and the lowest was(58.4±11.9)g/L.The incidences of leukopenia and thrombocytopenia were 37%(10 cases)and 7.4%(2 cases),respectively.14.8%(4 cases)of recip ients had elevated serum creatinine.The average erythrocyte life span of 16 renal transplant recipients within 2 months after operation was(80.2±30.5)days.3.Diagnosis and treatment strategies:Patients were diagnosed by PCR due to rapid decrease of h emoglobin(20 cases),EPO resistant anemia(3 cases)and sudden decrease of reticulocyte(4 cases).Administration of intravenous immunoglobulin,conversion of immunosuppressants and other comprehensive regimens were adopted.The accumulative dose of IVIG was(3.6±2.9)g/kg,and it is significantly lower in patients with early conversion of immunosuppressants than that in patients with delayed conversion and un-conversion immunosuppressants(P<0.001).4.Prognosis:Patients were followed up for(20.1±10.8)months,the hemoglobin was(124.3±25.2)g/L and the serum creatinine was(113.3±49.9)?mol/L.Parvovirus B19 DNA was negative in nine(34.6%)patients.Conclusions:The significant shortening of erythrocyte life span may explain the rapid decrease o f hemoglobin.Parvovirus B19 infection can be predicted by rapid decrease of reticulocyte.Satisfactory outcome may be obtained by using comprehensive measures such as IVIG and conversion of immunosuppressants.The dosage of IVIG may be reduced by an early conversion of immunosuppressants after diagnosis.The stable increase of hemoglobin rather than clearance of viral DNA ought to be the goal of treatment.