4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

4. Hrvatski kongres kliniËke citologije / 1. Hrvatski simpozij analitiËke citologije / 2. Hrvatski simpozij citotehnologije
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Klinička citologija - Posteri
POLYOMAVIRUS ASSOCIATED NEPHROPATHY AFTER SIMULTANEOUS KIDNEY AND
PANCREAS TRANSPLANTATION. CASE REPORT.
Gracin S1 , Knotek M1 , Sabljar Matovinovic M1 , Kardum Skelin I1 , Ljubanovic D2 , Vidas Z1 1 Clinical hospital Merkur, Zagreb, Croatia.
2 Clinical hospital Dubrava, Zagreb, Croatia.
In renal allograft recipient, immunosuppressive drug therapy is the major cause of immunocompromised
status and opportunistic infections leading to transplanted organ
failure.
During the last decade, polyomavirus virus associated nephropathy (PVAN) has been the
major cause of a serious complication allograft failure in these patients. The prevalence
of PVAN has increased from 1% to 10 % leading to loss of transplanted organ in 30% to
80% of cases. Viremia precedes PVAN, and in the absence of specific antiviral drugs,
early detection of disease and modification/reduction of immunosuppressive regimen
currently is the cornerstone of therapy.
Although PVAN nephropathy is well documented, it has not been thoroughly investigated
in nonrenal and/or multiple organ transplantation; such are simultaneous kidney and
pancreas transplantation (SPKT). In these specific conditions the diagnosis and therapy
of PVAN can be even more challenging problem.
We report a 32 years old patient who presented with PVAN 6 month after SPKT due to
diabetic nephropathy. He received induction immunosuppression which included IL-2
antibody (daclizumab), steroids, mycophenolate mofetil and tacrolimus. Diagnosis was
made on the basis of protocol cytologic study in urine, examining Decoy cell and confirmed
by histological examination of renal biopsy which revealed viral inclusions on
light microscopy as well as positive immunohistochemistry analysis. Patient was treated
with reduced immunosuppressive regimen, both tacrolimus and mycophenolate mofetil
with continuation of small dose of prednisone. At two years follow up, patient has preserved
kidney and pancreas function with estimated glomerular filtration rate of 84 ml/
min and no signs of PVAN on his 2 year protocol kidney biopsy.
sonja.gracin@gmail.com