Functional immune monitoring of BK Virus and donor-specific T-cell effector immune responses to guide treatment decision-making after kidney transplantation; an illustrative case report and literature review.
Marta LeporeElena CrespoEdoardo MelilliJosep M CruzadoAlba TorijaJosep M GrinyóOriol BestardPublished in: Transplant infectious disease : an official journal of the Transplantation Society (2020)
Differential diagnosis between Polyoma virus associated-nephropathy (PVAN) and T-cell mediated rejection (TCMR) might be challenging, as respective treatment approaches are totally opposite. Here we report the illustrative case of a kidney transplant recipient with PVAN who developed a persistent acute TCMR after full abrogation of viral infection through immunosuppression modulation. By simultaneous functional immune monitoring of BKV and donor-specific T-cell responses using IFN-γELISPOT assay, we retrospectively demonstrated the predominant effector mechanisms responsible of allograft injury and thus, potential guidance for treatment decision-making. Furthermore, the evidence of an efficient T-cell alloimmunity abrogation accompanied by a sustained anti-viral response after sirolimus addition, promotes the potential benefit of converting patients to an mTOR-based immunosuppression in case of PVAN.
Keyphrases
- decision making
- immune response
- dendritic cells
- liver failure
- ejection fraction
- newly diagnosed
- risk assessment
- intensive care unit
- cell proliferation
- chronic kidney disease
- patient reported outcomes
- inflammatory response
- human health
- drug induced
- climate change
- smoking cessation
- respiratory failure
- extracorporeal membrane oxygenation
- replacement therapy