Impact of Pretransplant Donor BK Viruria in Kidney Transplant Recipients

Abstract

Background BK virus (BKV) is a significant cause of nephropathy in kidney transplantation. The goal of this study was to characterize the course and source of BKV in kidney transplant recipients. Methods We prospectively collected pretransplant plasma and urine samples from living and deceased kidney donors and performed BKV polymerase chain reaction (PCR) and immunoglobulin G (IgG) testing on pretransplant and serially collected posttransplant samples in kidney transplant recipients. Results Among deceased donors, 8.1% (17/208) had detectable BKV DNA in urine prior to organ procurement. BK viruria was observed in 15.4% (6/39) of living donors and 8.5% (4/47) of deceased donors of recipients at our institution (P = .50). BKV VP1 sequencing revealed identical virus between donor–recipient pairs to suggest donor transmission of virus. Recipients of BK viruric donors were more likely to develop BK viruria (66.6% vs 7.8%; P < .001) and viremia (66.6% vs 8.9%; P < .001) with a shorter time to onset (log-rank test, P < .001). Though donor BKV IgG titers were higher in recipients who developed BK viremia, pretransplant donor, recipient, and combined donor/recipient serology status was not associated with BK viremia (P = .31, P = .75, and P = .51, respectively). Conclusions Donor BK viruria is associated with early BK viruria and viremia in kidney transplant recipients. BKV PCR testing of donor urine may be useful in identifying recipients at risk for BKV complications.

BK Virus-Associated Nephropathy after Renal Transplantation

“…Screening of healthy adults reported a positive rate of asymptomatic BK viruria of 7% [ 54 ]. BK viruria is observed in 8–16% of donors and recipients prior to transplantation [ 55 , 56 , 57 ]. After renal transplantion, detection of urinary BKV DNA of <5 log 10 copies/mL without any clinical problems is seen in approximately 10% [ 54 ].…”

BK Virus Nephropathy in Kidney Transplantation: A State-of-the-Art Review

“… Recipient characteristics: older age [ 33 , 46 ], diabetes [ 1 ], and specific HLA-C alleles [ 47 ] The donor–recipient interface: The high-risk serostatus of donor positive and recipient negative for BK virus [ 48 , 49 ], ABO incompatibility, HLA mismatch [ 50 ], delayed graft function [ 15 ], rejection or ischemia of the transplanted kidney [ 51 ], and ureteral stent placement [ 15 ]. Donor-related factors: reduced immune response to BK virus [ 48 , 52 ] and BK viruria prior to transplant [ 19 , 53 , 54 ]. …”

“…Donor-related factors: reduced immune response to BK virus [ 48 , 52 ] and BK viruria prior to transplant [ 19 , 53 , 54 ].…”

Polyoma BK Virus in Kidney Transplant Recipients: Screening, Monitoring, and Management

“…49 Native kidney BKPyVAN in other forms of solid organ transplantation is extremely rare and has only been reported in few cases. [50][51][52] While the most consistent risk factor for BKPyV infection is the overall intensity of immunosuppression and rejection episodes, 53 other predictors also include recipient (such as older age, male sex, a history of previous transplant, delayed graft function, and use of ureteral stent) 45 and donor factors (such as donor viruria, seroreactivity, and immune response) 30,[54][55][56] (Table 1). The association of BKPyV infection with diabetes and obesity is, however, inconsistent.…”