Clinical characteristics and outcomes of late-onset BK virus nephropathy in kidney and kidney-pancreas transplant recipients

Transpl Infect Dis. 2018 Aug;20(4):e12928. doi: 10.1111/tid.12928. Epub 2018 Jun 22.

Abstract

Background: BK virus nephropathy (BKPyVAN) is a major complication in kidney transplant recipients (KTR) and typically occurs within 1 year of transplant. Guidelines vary in recommendations for BKPyV screening beyond 1 year. A systematic characterization of risk factors and outcomes of late-onset (>1 year) BKPyVAN has not previously been reported.

Methods: We retrospectively compared characteristics and outcomes of early- (<1 year) and late-onset BKPyVAN (definitive [biopsy-confirmed] or presumptive [plasma BKPyV >10 000 copies/mL]) in a cohort of 671 KTR and simultaneous kidney-pancreas transplant (SPK) recipients between 2008 and 2013 at a single US transplant center. Proportions were compared using Chi-square or Fisher's exact test with P < .05 considered significant.

Results: BKPyVAN was diagnosed in 96 (14.3%) patients (proven 16.7%, presumptive 83.3%): 79 (82.3%) early- and 17 (17.7%) late-onset. The proportion with late-onset BKPyVAN was significantly higher among SPK than KTR (4 of 7 [57.1%] vs 13 of 89 [14.6%], P = .017). Late-onset represented "de novo" infection (no BKPyV detection within the first year) in 14 (82.4%) and progression of earlier lower grade BKPyV reactivation in 3 (17.6%). Clinical outcomes were similar for early- and late-onset BKPyVAN (P > .05 all comparisons). In a pooled analysis of prior studies of BKPyVAN in SPK recipients, 62.9% (17 of 27) were late-onset.

Conclusion: A significant proportion of BKPyVAN is late-onset, especially among SPK recipients, and supports a longer duration of BKPyV monitoring for SPK recipients than recommended in some guidelines.

Keywords: BK virus nephropathy; kidney transplantation; kidney-pancreas transplantation.

MeSH terms

  • Adult
  • Aged
  • BK Virus / isolation & purification*
  • Female
  • Graft Rejection / epidemiology
  • Graft Rejection / prevention & control
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Incidence
  • Kidney Diseases / diagnosis
  • Kidney Diseases / epidemiology*
  • Kidney Diseases / virology
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / methods
  • Male
  • Middle Aged
  • Pancreas Transplantation / adverse effects*
  • Pancreas Transplantation / methods
  • Polyomavirus Infections / diagnosis
  • Polyomavirus Infections / epidemiology*
  • Polyomavirus Infections / virology
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Survival Rate
  • Time Factors
  • Transplant Recipients
  • Tumor Virus Infections / diagnosis
  • Tumor Virus Infections / epidemiology*
  • Tumor Virus Infections / virology

Substances

  • Immunosuppressive Agents