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In kidney transplant recipients with BK polyomavirus infection, early BK nephropathy, microvascular inflammation, and serum creatinine are risk factors for graft loss
Author(s) -
Mohamed M.,
Parajuli S.,
Muth B.,
Astor B.C.,
Panzer S.E.,
Mandelbrot D.,
Zhong W.,
Djamali A.
Publication year - 2016
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12530
Subject(s) - medicine , kidney transplantation , creatinine , hazard ratio , urology , nephropathy , gastroenterology , panel reactive antibody , concomitant , peritubular capillaries , univariate analysis , transplantation , biopsy , renal function , kidney , confidence interval , multivariate analysis , diabetes mellitus , endocrinology
Background Little information is available on the risk factors for graft loss in kidney transplant recipients with BK polyomavirus ( BKP yV) nephropathy ( BKVN ) in the presence or absence of antibody‐mediated rejection ( AMR ). Methods We examined the risk factors for graft loss in consecutive kidney allograft recipients with biopsy‐confirmed BKVN , with or without concomitant AMR . Results A total of 1904 kidney transplants were performed at our institution during 2005–2011. Of these, 330 (17.33%) were diagnosed with BKP yV viremia, and 69 were diagnosed with BKVN (3.6%). Eleven patients had a concomitant diagnosis of AMR . Patients with AMR were characterized by significantly higher peak panel‐reactive antibody, retransplant rates, and desensitization preconditioning at the time of transplantation, as well as microvascular inflammation ( MVI = glomerulitis + peritubular capillaritis), C4d score, and donor‐specific antibody at the time of diagnosis ( P ≤ 0.01). Treatment with plasma exchange, intravenous immunoglobulin, and cidofovir was more prevalent in this group ( P ≤ 0.02). Univariate analyses assessing the risk factors for graft loss in all patients with BKVN , identified an independent association of African‐American race, deceased‐donor transplantation, serum creatinine (Scr), MVI , and early disease ( BKVN within 6 months of transplant) with poor outcomes. Multivariate analyses retained only 3 variables: Scr >2 mg/dL (hazard ratio [ HR ] = 4.3, 95% confidence interval [ CI ] 1.9–9.7, P = 0.0004), early BKVN ( HR = 2.7, 95% CI 1.3–5.3, P = 0.004), and MVI ( HR = 1.8, 95% CI 1.2–2.8, P = 0.008). Conclusions These observations suggest that, in patients with BK infection, early BKVN , Scr >2, and MVI are predictors of poor outcomes. Further studies are needed to determine effective treatment strategies for BKVN , with or without AMR .