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World J Transplant. 2017 Oct 24;7(5):269-275. doi: 10.5500/wjt.v7.i5.269.

Graft loss among renal-transplant recipients with early reduction of immunosuppression for BK viremia.

Author information

1
Department of Pathology, Section of Microbiology, Massachusetts General Hospital, Boston, MA 02145, United States.
2
Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States.
3
Adventist Health Partners, Chicago, IL 60521, United States.
4
Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, CT 06032, United States.
5
Division of Hypertension and Nephrology, University of Utah School of Medicine, Dalt Lake City, UT 84132, United States.
6
Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06510, United States.
7
Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, United States.

Abstract

AIM:

To review the incidence of graft loss and acute rejection among renal transplant recipients with early reduction of immunosuppression for BK viremia.

METHODS:

We performed a retrospective analysis of consecutive de-novo kidney-only transplants from January 2009 to December 2012 to evaluate the incidence of Polyoma-virus associated nephropathy (PyVAN). Recipient plasma was screened for BKV DNA via quantitative polymerase chain reaction (PCR) at months 1, 3, 6, 9 and 12 post-transplant and on worsening graft function. Immunosuppression was reduced at ≥ 3-log copies/mL. Those with viremia of ≥ 4-log copies/mL (presumptive PyVAN) underwent renal transplant biopsy. Presumptive PyVAN (PP) and definitive PyVAN (DP; biopsy-proven) were treated by immunosuppression reduction (IR) only.

RESULTS:

Among 319 kidney transplant recipients, the median age was 53 years (range 19-83), 65.8% were male, and 58.9% were white. Biopsy-proven acute rejection was found in 18.5% within 0-168 wk. Death-censored graft loss occurred in 5.3% (n = 17) and graft loss attributable to PyVAN was 0.6% (n = 2). Forty-seven patients were diagnosed with PP (14.7%) and 18 (5.6%) with DP. Graft loss among participants with PyVAN (8.5%) and those without (4.8%) was not significantly different. Deceased donor kidney transplantation (OR = 2.3, 95%CI = 1.1-4.6) and AR (OR = 2.3, 95%CI = 1.2-4.7) were associated with PyVAN in the multivariate analysis. BK viremia between 3 and 4-log copies/mL occurred in 27 patients, all of whom underwent IR. Of these, 16 (59%) never developed PyVAN while 11 (41%) developed PyVAN (4 DP, 7 PP) within a range of 11-39 wk.

CONCLUSION:

Instituting an early reduction of immunosuppression, in the absence of adjunctive antivirals, is effective at preventing PyVAN and may be associated with a lower incidence of graft-loss without a reciprocal increase in the incidence of acute rejection.

KEYWORDS:

BK virus; Graft loss; Prevention; PyVAN; Renal transplant; Screening

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