Clinical features of BK-polyomavirus and cytomegalovirus co-infection after kidney transplantation

Abstract

BK polyomavirus (BKPyV) and cytomegalovirus (CMV) are the main viral pathogens affecting the graft and recipient outcome after allogenic kidney transplantation. It has recently been found that infection with both viruses has a greater impact on kidney graft function than a single infection. We retrospectively analyzed a cohort of 723 recipients who received kidney transplantation between 2007 and 2015 after living and postmortal donation for differences in risk and outcome parameters regarding BKPyV (DNAemia) and CMV (CMV DNAemia) co-infection compared to sole viremias and to patients without viremia. Of all kidney allograft recipients in our cohort, 8.2% developed co-infection with BKPyV DNAemia and CMV DNAemia, 15.1% showed BKPyV viremia alone and 25.2% sole CMV DNAemia. Acute rejection was closely linked with co-infection (multivariable analysis, p = 0.001). Despite the fact that the estimated glomerular filtration rate of patients with co-infection was noticeably reduced compared to patients with BKV or CMV infection alone, transplant survival and patient survival were not significantly reduced. Co-infection with BKPyV and CMV in kidney transplanted patients is significantly associated with inferior allograft function. Since co-infection is strongly associated with acute rejection, co-infected individuals should be considered a risk collective.

BK Virus and Cytomegalovirus Coinfections in Kidney Transplantation and Their Impact on Allograft Loss

“…Cytomegalovirus infection was significantly associated with the development of BKVAN and was also the only risk factor associated with graft dysfunction and graft loss in these patients. Coinfection of BKV and CMV in kidney transplant recipients has been associated with allograft dysfunction in several studies [8,20], comparable to the findings of our study. While there are some data regarding the association of CMV and BKV viremia, data correlating CMV and BKVAN are scarce.…”

Risk Factors for Polyomavirus, Cytomegalovirus, and Viruria Co-Infection for Follow-Up of Renal Transplant Patients

“…The current study showed that more than 40% of viruria co-infection episodes were related to CMV and BK, which contrasted with Jehn et al, who showed that although CMV and BK accounted for most RTx patients, the CMV and BK co-infection were rare [ 10 ]. Our study illustrated that in RTx patients who were routinely screened for viruria, those with late detection had lower risk of repeated BKV, JCV, and CMV viruria infection than those with early detection.…”

“…The current evidence identified risk factors for each single viruria or co-infection. Potential risk factors of viral infection included the age of recipients at renal transplantation time, sex, renal function, donor age, deceased donor, immunosuppressive therapy, and co-morbidities [ 10 , 14 – 16 , 19 ]. Our study showed a negative association between age and risk of viruria infection.…”

“…The interaction of viral infection may be associated with increased post-RTx morbidity [ 9 ]. BKV and CMV co-infection have significantly lower eGFR after RTx than a single BK or CMV infection [ 9 , 10 ].…”

Risk factors and outcome of concurrent and sequential multiviral cytomegalovirus, Epstein–Barr virus, BK virus, adenovirus and other viral reactivations in transplantation

“…Risk factors for concurrent viral infections are often related to immunosuppression burden with reported various risk factors of interest outlined in Table 1. CMV donor seropositivity has been strongly identified as a risk factor for coinfection in two large observational studies [odds ratio (OR) 5.35, 95% confidence interval (95% CI) = 2.37–12.0, P < 0.00001; OR 3.97, 95% CI = 1.35–11.6, P = 0.0127] [16 ▪▪ ,17]. Donor/recipient (D/R) CMV serology mismatch was similarly identified as a risk factor (OR 3.648, 95% CI = 1.24–10.7) [17].…”