Acute renal failure in a pediatric kidney allograft recipient treated with intravenous immunoglobulin for parvovirus B19 induced pure red cell aplasia

Mihail M. Subtirelu, Joseph T. Flynn, Richard S. Schechner, James M. Pullman, Dianne Feuerstein, Marcela Del Rio

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Infection with parvovirus B19 (PV-B 19) after solid organ transplantation may cause pure red cell aplasia (PRCA). Intravenous immunoglobulin (IVIg) may be of benefit in clearing the infection. Acute renal failure is a known adverse effect of IVIg administration. A 14-yr-old male received a cadaveric renal transplant. Three weeks after surgery he developed symptomatic anemia (hemoglobin 4.5 g/dL, reticulocyte count 0.2%). Anti-PV-B19 IgM and IgG titers, which had been negative pretransplant, were positive. He received two IVIg infusions as treatment for the PV-B19 infection. Four days after the IVIg infusions he developed non-oliguric acute renal failure (ARF) with a rise in serum creatinine from 1 to 1.8 mg/dL. Allograft biopsy showed changes consistent with an osmotic load. Anemia and the renal failure resolved after transfusions and IVIg. PV-B19 infection in immunosuppressed transplant recipients is associated with significant morbidity and may respond to IVIg therapy. High sucrose IVIg preparations may be associated with renal failure in renal allograft recipients. Adding PV-B19 testing of the donor and recipient to the standard pretransplant evaluation may be beneficial in diagnosing and managing a potential infection. If IVIg is to be used it may be safer to use a sucrose-free IVIg preparation.

Original languageEnglish (US)
Pages (from-to)801-804
Number of pages4
JournalPediatric Transplantation
Volume9
Issue number6
DOIs
StatePublished - Dec 2005

Fingerprint

Pure Red-Cell Aplasia
Parvovirus
Intravenous Immunoglobulins
Acute Kidney Injury
Allografts
Pediatrics
Kidney
Infection
Intravenous Infusions
Renal Insufficiency
Sucrose
Anemia
Parvoviridae Infections
Reticulocyte Count
Passive Immunization
Organ Transplantation
Intravenous Administration
Immunoglobulin M
Creatinine
Hemoglobins

Keywords

  • Anemia
  • Children
  • Human parvovirus B19
  • Intravenous immunoglobulin
  • Kidney
  • Pure red cell aplasia
  • Renal failure
  • Transplant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Acute renal failure in a pediatric kidney allograft recipient treated with intravenous immunoglobulin for parvovirus B19 induced pure red cell aplasia. / Subtirelu, Mihail M.; Flynn, Joseph T.; Schechner, Richard S.; Pullman, James M.; Feuerstein, Dianne; Del Rio, Marcela.

In: Pediatric Transplantation, Vol. 9, No. 6, 12.2005, p. 801-804.

Research output: Contribution to journalArticle

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abstract = "Infection with parvovirus B19 (PV-B 19) after solid organ transplantation may cause pure red cell aplasia (PRCA). Intravenous immunoglobulin (IVIg) may be of benefit in clearing the infection. Acute renal failure is a known adverse effect of IVIg administration. A 14-yr-old male received a cadaveric renal transplant. Three weeks after surgery he developed symptomatic anemia (hemoglobin 4.5 g/dL, reticulocyte count 0.2{\%}). Anti-PV-B19 IgM and IgG titers, which had been negative pretransplant, were positive. He received two IVIg infusions as treatment for the PV-B19 infection. Four days after the IVIg infusions he developed non-oliguric acute renal failure (ARF) with a rise in serum creatinine from 1 to 1.8 mg/dL. Allograft biopsy showed changes consistent with an osmotic load. Anemia and the renal failure resolved after transfusions and IVIg. PV-B19 infection in immunosuppressed transplant recipients is associated with significant morbidity and may respond to IVIg therapy. High sucrose IVIg preparations may be associated with renal failure in renal allograft recipients. Adding PV-B19 testing of the donor and recipient to the standard pretransplant evaluation may be beneficial in diagnosing and managing a potential infection. If IVIg is to be used it may be safer to use a sucrose-free IVIg preparation.",
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