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  • Review Article
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Parvovirus-B19-associated complications in renal transplant recipients

Nature Clinical Practice Nephrology volume 3, pages 540–550 (2007)Cite this article

Abstract

Parvovirus B19 is a common human pathogen, causing erythema infectiosum in children, hydrops fetalis in pregnant women, and transient aplastic crisis in patients with chronic hemolytic anemia. Immunosuppressed patients can fail to mount an effective immune response to B19, resulting in prolonged or persistent viremia. Renal transplant recipients can develop symptomatic B19 infections as a result of primary infection acquired via the usual respiratory route or via the transplanted organ, or because of reactivation of latent or persistent viral infection. The most common manifestations of B19 infection in immunosuppressed patients are pure red cell aplasia and other cytopenias. Thus, this diagnosis should be considered in transplant recipients with unexplained anemia and reticulocytopenia or pancytopenia. Collapsing glomerulopathy and thrombotic microangiopathy have been reported in association with B19 infection in renal transplant recipients, but a causal relationship has not been definitively established. Prompt diagnosis of B19 infection in the renal transplant recipient requires a high index of suspicion and careful selection of diagnostic tests, which include serologies and polymerase chain reaction. Most patients benefit from intravenous immunoglobulin therapy and/or alteration or reduction of immunosuppressive therapy. Conservative therapy might be sufficient in some cases.

Key Points

  • Renal transplant recipients and kidney donors are not routinely tested for parvovirus B19 infection

  • Renal transplant recipients can develop symptomatic B19 infections as a result of primary infection acquired via the usual respiratory route or via the transplanted organ, or because of reactivation of latent or persistent viral infection

  • Pure red cell aplasia manifesting as chronic anemia is the most common presentation of B19 infection in immunosuppressed patients

  • Other cytopenias, as well as collapsing glomerulopathy and thrombotic microangiopathy, have been reported to be associated with B19 infection in renal transplant recipients

  • If B19 infection is suspected, serological tests for antibodies should be supplemented by a polymerase chain reaction assay to detect viral DNA

  • Pilot studies and case reports have shown that treatment with intravenous immunoglobulin and/or minimization of immunosuppression can effectively combat B19 infection

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Figure 1: Course of B19 viral infection in normal subjects, people with chronic hemolytic anemia, and immunosuppressed individuals.

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Acknowledgements

This Review was supported by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. We appreciate the critical review of the manuscript by Dr Jeffrey Miller.

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  1. Department of Health and Human Services, M Waldman is a nephrologist and clinical researcher, and JB Kopp is an investigator, in the Kidney Disease Section, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.,

    Meryl Waldman & Jeffrey B Kopp

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Correspondence to Meryl Waldman.

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Waldman, M., Kopp, J. Parvovirus-B19-associated complications in renal transplant recipients. Nat Rev Nephrol 3, 540–550 (2007). https://doi.org/10.1038/ncpneph0609

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