Taraz Jamshidi Shirin, Sajjadian Khadijeh, Emadzadeh Maryam, Saber Afsharian Malihe, Kalantari Mahmoud Reza, Alenabi Anita, Zeraati Abbas Ali, Emadzadeh Ali
Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad. Iran.
Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
Iran J Pathol. 2021 Spring;16(2):215-221. doi: 10.30699/IJP.2021.128489.2403. Epub 2021 Mar 2.
BACKGROUND & OBJECTIVE: Polyomavirus-associated nephropathy (PVAN), mainly caused by the BK virus, is one of the most important infectious complications of kidney transplantation. The leading histopathologic characteristics of PVAN is viral cytopathic effects, such as nucleomegaly with smudged or clumped chromatin and intranuclear ground-glass inclusion, mostly in tubular epithelial cells. Moreover, tubular necrosis, tubulitis, interstitial inflammation, atrophy, and fibrosis have been noted. Positive immunohistochemistry (IHC) staining for SV-40 highlights the infected epithelial cells of renal tubules.
A total of 85 core needle biopsies of transplanted kidneys were evaluated histologically and were stained for SV-40 using the IHC method. In addition, a follow-up of graft failure was performed.
Our findings revealed that the frequency of polyomavirus infection in kidney transplant patients in the Northeast of Iran is 4.7%. There was no significant correlation between PVAN and graft rejection. Although a higher rate of graft loss was observed in PVAN patients, in comparison with non-PVAN patients (25% vs. 14.8%), the difference was not statistically significant. Moreover, patients with immunohistochemically confirmed PVAN and those with histopathologic features of viral-like cytopathic effects had significantly lower graft survival in the follow-up period (42.5 vs. 196.8 months and 109.4 vs. 205.7 months, respectively).
The frequency of polyomavirus infection in kidney transplant patients in the Northeast of Iran is 4.7%. There was no significant correlation between PVAN and graft rejection. Furthermore, we observed that polyomavirus infection accelerates the course of graft loss.
多瘤病毒相关性肾病（PVAN）主要由BK病毒引起，是肾移植最重要的感染性并发症之一。PVAN的主要组织病理学特征是病毒细胞病变效应，如核肿大伴染色质模糊或聚集以及核内毛玻璃样包涵体，主要见于肾小管上皮细胞。此外，还可见肾小管坏死、肾小管炎、间质炎症、萎缩和纤维化。SV-40免疫组化（IHC）染色阳性可突出显示肾小管的感染上皮细胞。
对85例移植肾的粗针活检标本进行组织学评估，并采用IHC方法对SV-40进行染色。此外，对移植肾失功情况进行随访。
我们的研究结果显示，伊朗东北部肾移植患者的多瘤病毒感染率为4.7%。PVAN与移植肾排斥反应之间无显著相关性。尽管PVAN患者的移植肾丢失率高于非PVAN患者（25%对14.8%），但差异无统计学意义。此外，免疫组化确诊为PVAN的患者以及具有病毒样细胞病变效应组织病理学特征的患者在随访期内的移植肾存活率显著较低（分别为42.5个月对196.8个月和109.4个月对205.7个月）。
伊朗东北部肾移植患者的多瘤病毒感染率为4.7%。PVAN与移植肾排斥反应之间无显著相关性。此外，我们观察到多瘤病毒感染会加速移植肾丢失进程。
