Polyomavirus Allograft Nephropathy
A 59-year-old African-American male with end-stage renal disease of unclear etiology underwent a cadaver renal transplant in May 2001. Following transplantation, the patient had delayed graft function requiring several hemodialysis treatments. The patient was started on immunosuppression consisting of sirolimus (first dose 15 mg, followed by a maintenance dosage of 10 mg/day, target level 10-20 ng/mL), mycophenolate mofetil (MMF) 1 g twice daily, and corticosteroids. He also received 1 dose (2 mg/kg) of daclizumab within 12 hours after transplantation. On posttransplant day 7, because of lack of improvement in renal function, the patient underwent a kidney biopsy, which revealed mild acute tubular necrosis and acute cellular rejection (Banff IA). The patient was started on a 7-day course of thymoglobulin. Within 5 days, the serum creatinine level began to decline (6 mg/dL). Sirolimus was discontinued and the patient was started on tacrolimus (TAC). Discharge immunosuppression consisted of TAC 5 mg twice daily, MMF 1 g twice daily, and corticosteroids 30 mg per day. Six weeks after transplantation, the serum creatinine level reached a nadir of 1.8 mg/dL and the BUN was 24 mg/dL. The patient was maintained on TAC 5 mg twice daily, MMF 1 g twice daily, and prednisone 7.5 mg daily. The TAC level range was 7-10 ng/mL.