A CASE SERIES OF POST TRANSPLANT - PARVOVIRUS B19 INDUCED ANAEMIA TREATED WITH NOVEL HIF-PHI: DESIDUSTAT

Introduction:

Parvovirus B19 is a DNA virus from the parvoviridae family that selectively targets red blood cell precursors by binding to the P antigen. It can cause significant anemia, particularly in immunocompromised patients such as renal transplant recipients. Management of Parvovirus B19-induced anemia typically involves reducing immunosuppressive therapy, intravenous immunoglobulin (IVIg), and blood transfusions. Desidustat, a HIF-PHI approved in India for CKD related anaemia, increases endogenous erythropoietin production via HIF-PHI pathway. In this case series, we report the outcomes of three renal transplant recipients with Parvovirus B19-induced anaemia treated with desidustat

Methods:

This is a series of three cases from the Institute of Nephro-urology, Bangalore where renal transplant recipients with parvo B19 infection received standard of care and desidustat as well.

Results:

Case 1: A 38-year-old female who underwent a live-related renal transplant with no induction, wherein the post-operative course was complicated by acute ABMR and ACMR for which she received plasma exchange, low dose IV Ig and rituximab in the immediate post-transplant period. At 8 weeks post-transplant she developed severe anaemia. She was detected to have parvo B19 and received high dose IVIg and red blood cell transfusions as well. Desidustat was initiated at 100 mg thrice weekly due to persistent anemia despite erythropoietin therapy. Within 15 days, her Hb increased to 11.5 g%, and her reticulocyte count rose to 4%. On rechallenge with mycophenolate, she again developed anaemia and it was withdrawn. She was continued on desidustat. Haemoglobin again improved and desidustat was discontinued following 1 month of stable Hb levels, the patient maintained stable graft function and Hb without recurrence of severe anemia.

Case 2: A 44-year-old male, post-live-related renal transplant, who received ATLG induction and triple drug maintenance immunosuppression developed anaemia (Hb 6 g%) around 8 weeks post-transplant. He was evaluated and diagnosed with parvo B19 anaemia and received IVIg and two transfusions, however his Hb failed to improve significantly. Desidustat (100 mg thrice weekly) was started, and a brisk response was noted. The Hb increased from 6.5g% to 9 g% and reached 13 g%, with a reticulocyte count of 7%. He tolerated the gradual reintroduction of mycophenolate mofetil, and Desidustat was stopped after 45 days with stable Hb and graft function thereafter.

Case 3: A 45-year-old male underwent a deceased donor renal transplant complicated by delayed graft function and thrombotic microangiopathy (TMA). He developed pancytopenia and severe anemia (Hb 6 g%) which didn’t improve despite treatment of the TMA with plasmapheresis, IVIg and rituximab. Subsequently high Parvoviral load was detected. MMF withdrawal did not lead to hematologic improvement. Desidustat was introduced at 300 mg weekly, later increased to 400 mg. His Hb gradually improved to 9 g% over several weeks, with a reticulocyte count of 3%. Despite persistent Parvovirus B19 viremia, he continued to show hematologic improvement on Desidustat with stable graft function.

In this series, Desidustat demonstrated effectiveness in treating anaemia caused by Parvovirus B19 in renal transplant recipients. Two of the three patients showed a rapid hematologic response with improved Hb and reticulocyte counts. The third patient had a more complex clinical course but also showed incremental improvement with Desidustat therapy. Desidustat appears to be a promising adjunctive therapy in Parvovirus B19-related anaemia along with IVIg and reduction of immunosuppression. 

Conclusions:

This case series highlights the potential of Desidustat as an adjunctive treatment for Parvovirus B19-induced anaemia in renal transplant recipients. The advantage of use includes ease of use, orally and is cost effective as well. However, long term outcomes of desidustat use and duration of therapy is uncertain as literature is unavailable with respect to use of the drug in parvo related anaemia. Large scale studies are required to definitely establish the role of Desidustat in Parvovirus B19 induced anaemia, especially when the response to standard therapy and erythropoietin is suboptimal.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.