Transplant Rejection Questions

[Andy55]

Hi All,
Just got off the phone with my xplant surg. He says I have two issues that have cropped up (suddenly).

My transplant was in Nov 2008 from a non-related living donor. I have PKD.

A recent biopsy showed 1) mild rejection and 2) evidence of the "BK" virus.

Kidney function is holding steady, Creatine=1.8

Questions:
1. Anyone have experience with this combo (rejection & BK)? Please share!
2. Has anyone in this blog bounced back from rejection, details? What was the treatment plan?

Just when I thought I was out of the woods...any links to good articles, clinicals, etc. would be appreciated.

Thanks!!

Andy55

[kellyt]

I have no experience with rejection or BK virus, but did also get a non-related living donor in Nov 2008.  I hope everything can get under control for you.  What's the plan of action?  Will they admit you?  IVIG treatments?  What?  I'm very interested.  Please keep us posted.   

Kelly

[okarol]

Here's a related thread: Creatinine elevated, what has your doctor done? http://ihatedialysis.com/forum/index.php?topic=5506.0
and BK virus http://ihatedialysis.com/forum/index.php?topic=11128.0

I hope this helps. Good luck to you 

[Andy55]

Thanks Kelly and Carol,
I just got the call today and going to Cleveland Clinic on Thursday for addtional tests, biopsy, etc. The first thing the doc did was lower my cellcept to try and get my body fight the virus. That was before the biopsy result of the beginning of rejection. I am sure he will have a game plan ready on Thursday. I am exactly 3 months since tranplant. I'll keep you posted!

[kellyt]

I transplanted on Nov. 5th at Christus Santa Rosa Transplant Hospital in San Antonio, TX.  Where and when was your transplant?

[Run8]

Hey Andy I don't know about know about bk but I was going though some mild rejection. My creatine was up to 2.0 so they put have me 7 days of OKT3. They had to put a central line in my neck and the side effects are not good but it seemed to work. It brought my creatine down to 1.4. It is a 7 to 14 day treatment depending how it works for you.

[Wenchie58]

Andy
  I had my transplant Oct 24th 2008 and suffered from immediate rejection.  Now I dont claim to be an expert..this is how one of my Tx docs explained it to me....in ENGLISH!  He said there were two types of rejection: cellular and antibody types.  I had both.  I was treated with 12 sessions of plasma pheresis and 10 IVIG treatments....sent those antibodies to the promised land.  I havent had any issues since, but my creat. levels are consistantly high   1.5 - 1.8.  Wishing the best for you!!

[pelagia]

I just read numerous abstracts for journal articles and collected select excerpts of those in the attached document as it would be really long to dump them in here.  One particularly readable/informative abstract is below.  Unfortunately, quite a bit of the research on BK virus is relatively recent and for that reason the published journal content is not open access.  Very frustrating!

As best as I can tell, the use of stronger immunosuppressive drug regimes is giving opportunistic viruses “a foot in the door” in transplant patients.  As noted below, infection with BK virus can lead to allograft loss.  One article I read states that “Reduction in immunosuppression is generally advocated as the initial therapeutic option for the management of BKV.”  A number of the articles mention that Cidofovir, an anti-viral agent with known nephrotoxic effects, has been successfully used in very low doses to treat patients with BKV associated nephropathy. Some very recent articles cover other drug therapies but the abstracts for those are hidden except for subscribers.  I also found one article in which the authors “propose that HLA mismatching promotes the development of BKV nephropathy through rejection-related inflammatory processes and heavy immunosuppression which cause virus reactivation and injury of the tubular epithelium.”

It sounds like your docs caught this early and hopefully they will be able to knock it down to a manageable state.  

***********

http://www.springerlink.com/content/x0r5306l11828h27/

Irfan Agha and Daniel C. Brennan

Advances in Experimental Medicine and Biology 2007
Polyomaviruses and Human Diseases

Abstract

The last decade has witnessed the introduction of several potent immunosuppressive agents in the field of transplant medicine. Contemporaneously, infection with BK virus (BKV) has emerged as an important complication of immunosuppression and an important cause of allograft loss after kidney transplantation. Rhandhawa et al reported the first case of BKV associated nephropathy (BKVN) in the modern era of transplantation, in 1995. Since then there has been a resurgence of interest in the epidemiology, biology and pathogenic associations of BKV especially in transplant medicine. Up to 90% of adults have serologic evidence of exposure to BKV. However, only 1–5% of normal healthy adults excrete the virus in the urine (asymptomatic viruria). Thus, for a vast majority of the population, the virus remains perfectly latent and this state of latency is of no obvious consequence. Almost all instances of disease by the BKV have been seen in immunocompromised patients. In recent years, BKV has been associated with nephropathy (BKVN) in about 5% of renal transplant patients. Once established, the disease may result in allograft loss in 45–70% of patients. Although not proven by any prospective study, BKVN causing allograft failure has been linked to immunosuppressive regimens containing tacrolimus or mycophenolate mofetil. This is noteworthy, as both these agents have been used increasingly as the primary maintenance immunotherapy in solid organ transplantation since their introduction around 1990. In addition to the immunosuppressed state, other factors like allograft injury have been thought to be involved in the pathogenesis of the disease. We believe that reactivation of the BKV from its latent state crucially depends on an immunocompromised state but more factors than one dictate precipitation of clinical end organ disease.

[Andy55]

I have no experience with rejection or BK virus, but did also get a non-related living donor in Nov 2008.  I hope everything can get under control for you.  What's the plan of action?  Will they admit you?  IVIG treatments?  What?  I'm very interested.  Please keep us posted.   

Kelly

Kelly, Quick update...they lowered my anti-rej meds so my body could fight BKV (which I am learning is a real beast if you let it get out of control)...BK is dropping from 50000 to 7000......rejection has stopped.....so looking okay for now....thank you for your encouragement!
Andy

[thegrammalady]

glad to hear things are going bettet.

[kellyt]

Andy, that's wonderful news.   After transplant they told me I was CMV negative and my donor was positive, when before transplant they had told me I was positive.  Anyway, I had to have 7 sessions of an IVIG treatment at the hospital since transplant.  They started off every two weeks (roughly 3-5 hrs, including admit and hook-up and such) and the last two are once monthly (my last treatment will be next week).  It's been a huge pain in the arse, but I'm glad they caught their mistake.  CMV (cytomegaly virus) is also very terrible (so I hear).  I was fortunate enough to avoid dialysis, so if anything were to happen and I were to lose my kidney I would be devastated, as I'm sure you would, too!

Definitely keep me posted. You can PM me or even email me.

I'm glad things are looking better for you and your kidney.   

[pelagia]

It's really good to hear that they have this under control. 

[paris]

Glad the doctors are on top of everything.      yea for new kidneys!!