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De novo donor‐specific antibody following BK nephropathy: The incidence and association with antibody‐mediated rejection
Author(s) -
Cheungpasitporn Wisit,
Kremers Walter K.,
Lorenz Elizabeth,
Amer Hatem,
Cosio Fernando G.,
Stegall Mark D.,
Gandhi Manish J.,
Schinstock Carrie A.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13194
Subject(s) - medicine , bk virus , immunosuppression , risk factor , population , proportional hazards model , kidney transplantation , immunology , nephropathy , antibody , kidney disease , cohort , kidney , endocrinology , environmental health , diabetes mellitus
Abstract Background and objectives The risk of de novo donor‐specific antibody (dn DSA ) development following BK viremia ( BKV ) or nephropathy ( BKN ) after kidney transplant remains unclear. We aimed to evaluate the relationships among dn DSA , BKV ( BK blood PCR > 15 000 copies), BKN , antibody‐mediated rejection ( AMR ), and allograft loss. Patients and methods We performed a retrospective cohort study of 904 solitary kidney transplant recipients transplanted between 10/2007 and 5/2014. Cox proportional hazards regression with time‐dependent covariates were used to assess the relationships among BKN , isolated BKV , dn DSA , and the subsequent risk of AMR and allograft loss. Results In multivariate analysis, we observed that BKN , but not BKV was a risk factor for dn DSA ( HR , 3.18, P = .008). Of the patients with BK nephropathy, 14.0% (6/43) developed dn DSA , which occurred within 14 months of BK diagnosis. Dn DSA in this setting remains a risk factor for subsequent AMR ( HR 4.75, P = .0001) and allograft loss ( HR 2.63, P = .018). Conclusions BKN is an independent risk factor for development of dn DSA . Improved understanding of the characteristics of patients with BKN who are at highest risk for development of dn DSA would be valuable to customize immunosuppression reduction in this population.