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Which is more nephrotoxic for kidney transplants: BK nephropathy or rejection?
Author(s) -
Parajuli Sandesh,
Astor Brad C.,
Kaufman Dixon,
Muth Brenda,
Mohamed Maha,
Garg Neetika,
Djamali Arjang,
Mandelbrot Didier 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.13216
Subject(s) - medicine , kidney , kidney transplantation , histocompatibility testing , nephropathy , kidney transplant , immunology , endocrinology , diabetes mellitus
Little data exist comparing outcomes following BK nephropathy ( BKN ) vs acute rejection. We reviewed outcomes among recipients who had a primary diagnosis of biopsy‐proven BKN or rejection between 1 and 18 months post‐transplant. There were 96 cases of BKN and 256 cases of rejections. We compared outcomes of BKN with all rejection combined and also with cellular rejection. Seven of 256 (2.7%) patients developed BKN after treatment of rejection. Conversely, 8 of 96 (8.3%) developed rejection after BKN . The eGFR at time of diagnosis in the BKN group (33.7 ± 12.6) was lower than the rejection group (44.8 ± 23.3, P < .001). The eGFR at 6 months after diagnosis of BKN was 32.7 ± 14.9 and for rejection was 48.8 ± 20.7 ( P ≤ .001). The mean eGFR at 3 years postdiagnosis was 41.6 ± 18.5 in BKN and 53 ± 21.3 for rejection ( P = .001). The graft failure incidence rates were similar between 2 groups. A similar pattern was observed comparing BKN with cellular rejection. While the difference in rate of graft loss between BKN and rejection did not reach statistical significance, kidney function up to 3 years after diagnosis was worse for BKN than for rejection, suggesting that BKN is at least as damaging to kidneys as rejection.