Clinical characteristics and outcomes of late‐onset BK virus nephropathy in kidney and kidney‐pancreas transplant recipients. Issue 4 (22nd June 2018)

• Record Type: Journal Article
• Authors: Imlay, Hannah; Whitaker, Kathryn; Fisher, Cynthia E.; Limaye, Ajit P.
• Is Part Of: Transplant infectious disease. Volume 20:Issue 4(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-06-22
• Subjects: BK virus nephropathy -- kidney transplantation -- kidney‐pancreas transplantation; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12928
• Languages: English
• ISSNs: 1398-2273

Abstract

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.