What is the treatment for Parvovirus (Parvovirus B19) infection after renal transplant?

Treatment of Parvovirus B19 Infection in Renal Transplant Recipients

Intravenous immunoglobulin (IVIG) at a total dose of 2 g/kg administered over 2-5 days is the recommended treatment for parvovirus B19 infection in kidney transplant recipients. 1

Clinical Presentation and Diagnosis

• Parvovirus B19 infection in renal transplant recipients typically presents with:
  • Severe anemia or pancytopenia with inadequate reticulocyte response 2
  • Potential allograft dysfunction 2
  • Fever and polyarthralgia in some cases 2
• Diagnosis should include:
  • Serological testing for anti-parvovirus B19 IgM and IgG 2
  • PCR detection of parvovirus B19 DNA in blood and/or renal tissue 2, 1
  • Renal biopsy may show tubular damage or various forms of glomerulopathy 2

Treatment Protocol

• First-line treatment:

  • IVIG at a total dose of 2 g/kg divided over 2-5 days 1
  • Daily doses should be kept below 1 g/kg to reduce toxicity risk 1
  • Consider using sucrose-free IVIG preparations to minimize risk of acute renal failure 3

• Monitoring during treatment:

  • Complete blood count to assess response 2
  • Renal function tests (serum creatinine) 3
  • PCR for parvovirus B19 DNA to confirm viral clearance 4

Management of Immunosuppression

• Consider temporary reduction of immunosuppressive medications to allow immune recovery 5
• This approach should be balanced against the risk of allograft rejection 5
• Monitor graft function closely during any adjustment of immunosuppression 5

Treatment Response and Follow-up

• Most patients show excellent response to IVIG with:
  • Normalization of blood counts 2
  • Improvement of allograft function to baseline 2
• Persistent or recurrent infection may require additional courses of IVIG 4
• Regular monitoring with PCR for parvovirus B19 DNA is recommended post-treatment 4

Special Considerations

• Acute renal failure is a potential complication of IVIG therapy, particularly with high-sucrose IVIG preparations 3
• Patients with pre-transplant parvovirus B19 infection should be treated and confirmed negative by PCR before transplantation to prevent recurrence 4
• Standard and droplet isolation precautions should be implemented to prevent transmission 1

Prevention

• Consider screening high-risk transplant candidates for parvovirus B19 before transplantation 4
• For patients with history of parvovirus B19 infection, confirm viral clearance with negative PCR before transplantation 4