BK polyomavirus infection after renal transplantation: Surveillance in a resource‐challenged setting

Background There is a paucity of data available about BK polyomavirus ( BKP yV) infection after renal transplantation ( RTX ) in resource‐limited countries with a predominantly living‐donor, ABO ‐compatible RTX program. We aimed to assess BKP yV infection in such patients in a public hospital in India. Methods We prospectively evaluated plasma BKP yV replication in 62 patients at 1, 3, 6, 9, and 12 months after RTX . Sustained significant BK viremia ( SSBKV ) was defined as significant viremia (≥10 000 copies/mL) detected ≥2 times, and BKP yV‐associated nephropathy ( BKVAN ) as histologic changes of BKVAN with BK viremia with/without graft dysfunction. Results All patients underwent RTX without requiring desensitization. Incidence of BK viremia was: 17.7%, 41.9%, 16.1%, 25.8%, and 17.7% at 1, 3, 6, 9, and 12 months, respectively. Of 62 patients, 64.5% had BKP yV viremia during the study, 32.2% had significant viremia, all except one detected in the first 6 months. Nine (14.5%) patients had SSBKV . There was no biopsy‐proven BKVAN. At the end of 1 year, mean serum creatinine was higher and graft dysfunction was significantly more common in patients with SSBKV compared to those without SSBKV . Conclusion Transient BK viremia is common in low/intermediate immunologic risk RTX recipients in India, with a peak occurring at 3‐6 months. Most clear their viremia by 12 months. Graft dysfunction seems to be more frequent in patients with SSBKV , although BKVAN is uncommon on biopsy in these patients.