{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T20:36:36Z","timestamp":1773174996890,"version":"3.50.1"},"reference-count":14,"publisher":"Associacao Brasileira de Transplantes de Orgaos","issue":"1","license":[{"start":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T00:00:00Z","timestamp":1723420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BJT"],"abstract":"<jats:p>Parvovirus B19 (PVB19)-associated pure red cell aplasia (PRCA) is an important diagnosis to consider in kidney transplant (KT) recipients experiencing persistent anemia, in whom other etiologies have been excluded. Its management poses a challenge since reducing immunosuppression (IS) to address the viral infection needs to be carefully balanced with the increased risk of allograft rejection.  The  authors  describe  a  case  of  a  43-year-old  male  with  a  history  of  chronic  kidney  disease  of  unknown  etiology  who  underwent a KT from a deceased donor after circulatory death in January 2021. In the 1st year post-KT, the patient was repeatedly admitted  due  to  the  recurrence  of  PVB19-associated  PRCA,  requiring  blood  transfusions  and  intravenous  immunoglobulin  (IVIG).  IS  was  initially  adjusted  with  mycophenolate  mofetil  (MMF)  suspension  and  later  transitioned  to  a  TRANSFORM  scheme with prednisolone, tacrolimus, and everolimus. Due to deteriorating kidney function, a kidney biopsy was performed and revealed  borderline  acute  T-cell  mediated  rejection  with  significant  signs  of  chronicity  (50%  of  interstitial  fibrosis  and  tubular  atrophy). To guarantee infection control, IS was not increased. Considering the recurrence of PVB19-associated PRCA, despite the use of a TRANSFORM IS scheme in a patient with chronic allograft dysfunction and high immunologic risk, maintenance therapy with IVIG (0.4 mg\/kg) every 4 weeks was started. After 9 months of maintenance therapy, no relapse was identified. To promote an individualized IS prescription, an ImmunoBiogram\u00ae was recently performed and an IS reduction is planned, followed by  an  ImmunoBiogram\u00ae  control,  which  will  potentially  allow  the  suspension  of  IVIG  maintenance  therapy.  The  diagnosis  and  management  of  PVB19-associated  PRCA  is  challenging.  Regarding  recurrent  disease,  prolonged  IVIG  treatment  appears  to  be  a useful treatment strategy, but more studies are necessary to ascertain its role. It is also fundamental to tailor the IS as much as possible to the individualized immunologic profile of the patients to prevent overimmunosuppression.<\/jats:p>","DOI":"10.53855\/bjt.v27i1.603_eng","type":"journal-article","created":{"date-parts":[[2024,8,17]],"date-time":"2024-08-17T13:08:43Z","timestamp":1723900123000},"source":"Crossref","is-referenced-by-count":1,"title":["Recurrent Parvovirus B19-Associated Pure Red Cell Aplasia:  A Challenging Disease in Kidney Transplantation"],"prefix":"10.53855","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4601-0920","authenticated-orcid":false,"given":"N\u00faria","family":"Paulo","sequence":"first","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8616-3430","authenticated-orcid":false,"given":"Carolina","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de Viseu D\u00e3o Laf\u00f5es"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5799-0883","authenticated-orcid":false,"given":"Ana","family":"Cerqueira","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8626-9235","authenticated-orcid":false,"given":"Susana","family":"Sampaio","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1482-2024","authenticated-orcid":false,"given":"Manuel","family":"Pestana","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade de S\u00e3o Jo\u00e3o"}]}],"member":"32043","published-online":{"date-parts":[[2024,8,12]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Sharma N, Bajwa R. Parvovirus infection-related anemia after kidney transplantation. Case Rep Transplant 2020:6437392. https:\/\/doi.org\/10.1155\/2020\/6437392","DOI":"10.1155\/2020\/6437392"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Gang S, Park S, Min SI, Hong J, Chang YH, Ha J, et al. Recurrent parvovirus B19 infection-associated pure red cell aplasia in a kidney transplant patient. Korean J Transplant 2020;34(3):199-203. https:\/\/doi.org\/10.4285\/kjt.2020.34.3.199","DOI":"10.4285\/kjt.2020.34.3.199"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Thongprayoon C, Khoury NJ, Bathini T, Aeddula NR, Boonpheng B, Lertjitbanjong P, et al. Epidemiology of parvovirus B19 and anemia among kidney transplant recipients: a meta-analysis. Urol Ann 2020;12(3):241-7. https:\/\/doi.org\/10.4103\/UA.UA_89_19","DOI":"10.4103\/ua.ua_89_19"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"An HPH, Diem HT, Cuong NT. 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