Pure Red Cell Aplasia After Kidney Transplantation: Parvovirus B19 Culprit or Coincidence?

BACKGROUND Anemia is present even in long-term observation after kidney transplantation. Observational study results indicate the presence of chronic post-transplantation anemia in 1 in 3 recipients. An extreme form of erythroid line dysfunction is pure red cell aplasia (PRCA). It may be caused by immunosuppressive treatment per se or a side effect, opportunistic pathogen activation. Parvovirus B19 (PV B19) infection is quite likely the cause of refractory normocytic anemia in immunocompromised patients. CASE REPORT In this case report we discuss biological and clinical features of this phenomenon and the treatment strategies, based on 2 PRCA cases in kidney transplant recipients. Additionally, a systematic review of published reports of PV B19 related PRCA in kidney recipients is presented. CONCLUSIONS PV replication should be ruled out in cases of persistent and/or refractory anemia after kidney transplantation. The established first-line treatment of PRCA is passive immunization. Taking into account cost effectiveness, a decrease in immunosuppression load is reasonable under careful control of allograft function.