Incidence and risk factors for high-level BK viruria: a single center study in China

Xiong, Rui; Ye, Haimin; Liu, Zhujing; Li, Xinchang

doi:10.1186/s12985-020-01460-5

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…As with the studies performed in other centers, the incidence of BK viruria in our center was the highest within six months after surgery; we then observed a downwards trend, with an increased incidence two years after surgery (22,23). Currently, there is no speci c antiviral therapy for BKV-related diseases.…”

Section: Discussionsupporting

confidence: 83%

Correlation between donor acute kidney injury and recipient BK viruria after surgery

Liu

Kong

Wang

et al. 2023

Preprint

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Background Donor acute kidney injury (AKI) may provide more donor kidney sources to organ banks and provide more transplant opportunities for patients suffering from kidney failure. The BK virus normally resides in the human body and is more likely to be activated in kidney transplant recipients. BK viruria occurs following the infection of kidney transplant recipients with the BK virus (BKV); this is followed by BK viremia. When BKV reaches the transplanted kidney, it will increase the probability of renal graft loss. Few studies have investigated the relationship between donor AKI and recipient BK viruria. In this study, we investigated the relationship between donor AKI and recipient BK viruria to provide more donor kidney sources for kidney transplantation. Methods We performed retrospective analysis on 338 kidney transplant recipients in our hospital between 2018 and 2021. These were divided into a BK viruria group and a non-BK viruria group. The initial donor and kidney transplantation characteristics of the two groups were evaluated, and the association between donor AKI and BK viruria was analyzed by univariate, multivariate and subgroup analysis. Results At the median follow-up time of 826 days (range: 527–1176) days, 55 of renal transplantation patients developed BK viruria; thus, the incidence of BK viruria was 16.3%. Approximately, 47.3% of BK viruria occurred within six months after kidney transplantation. Compared with the non-BK viruria group, the age (58[48,64] vs 53[45,60], P = 0.014), Kidney Donor Profile Index (KDPI) (0.83[0.70, 0.92] vs 0.71[0.49, 0.87], P = 0.005)and Kidney Donor risk Index (KDRI) (1.42[1.22, 1.66] vs 1.24[0.99, 1.50], P = 0.005) of the corresponding donor were higher, the sCr before kidney transplantation(814.00 [640.50, 1085.00] vs 983.00 [781.00, 1194.00], P = 0.006), along with the proportion of patients with a Panel Reactive Antibodies (PRA) > 10% prior to surgery (5.5% vs 17.3%, P = 0.024), and the serum creatinine (sCr) 21 days after surgery (94.00 [78.00, 115.50] vs 105.00 [83.00, 136.50], P = 0.04) in the recipient were lower, and the Estimated Glomerular Filtration Rate (eGFR) prior to surgery (5.19 [4.06, 8.09] vs 4.61 [3.72, 6.32], P = 0.016) was higher. No independent association was detected between donor AKI and BK viruria by univariate, multivariate, or subgroup analyses. Conclusions In this single-center study, we found that there was no correlation between donor AKI and postoperative BK viruria with regards to donor after cardiac death (DCD). Thus, AKI donor kidneys can be used to alleviate organ shortages.

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Section: Discussionsupporting

confidence: 83%

Correlation between donor acute kidney injury and recipient BK viruria after surgery

Liu

Kong

Wang

et al. 2023

Preprint

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“…Many clinical studies have reported risk factors for BKVAN. Representative risk factors are renal transplantation from deceased donors, episodes of acute rejection, and Tacrolimus and/or MMF-based maintenance immunosuppression [ 17 , 18 ]. In addition, several factors associated with donors, recipients, and others have been proposed as promoting a high risk of BKVAN development ( Table 1 ).…”

Section: Risk Factorsmentioning

confidence: 99%

BK Virus-Associated Nephropathy after Renal Transplantation

Funahashi

2021

Pathogens

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Recent advances in immunosuppressive therapy have reduced the incidence of acute rejection and improved renal transplantation outcomes. Meanwhile, nephropathy caused by BK virus has become an important cause of acute or chronic graft dysfunction. The usual progression of infection begins with BK viruria and progresses to BK viremia, leading to BK virus associated nephropathy. To detect early signs of BK virus proliferation before the development of nephropathy, several screening tests are used including urinary cytology and urinary and plasma PCR. A definitive diagnosis of BK virus associated nephropathy can be achieved only histologically, typically by detecting tubulointerstitial inflammation associated with basophilic intranuclear inclusions in tubular and/or Bowman’s epithelial cells, in addition to immunostaining with anti-Simian virus 40 large T-antigen. Several pathological classifications have been proposed to categorize the severity of the disease to allow treatment strategies to be determined and treatment success to be predicted. Since no specific drugs that directly suppress the proliferation of BKV are available, the main therapeutic approach is the reduction of immunosuppressive drugs. The diagnosis of subsequent acute rejection, the definition of remission, the protocol of resuming immunosuppression, and long-term follow-up remain controversial.

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“…Several studies have explored the relevant static factors of BKV replication in renal transplant recipients with inconsistent results (8)(9)(10)(11)(12)(13)(14)(15)(16); in particular, the effect of immunosuppressive regimens on BKV replication remains controversial. For example, rapamycin (mTOR) inhibitors could inhibit BKV replication, whereas tacrolimus has the opposite effect, according to the research of Hirsch et al (14).…”

Section: Introductionmentioning

confidence: 99%

Dynamic risk prediction of BK polyomavirus reactivation after renal transplantation

et al. 2022

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PurposeTo construct a dynamic prediction model for BK polyomavirus (BKV) reactivation during the early period after renal transplantation and to provide a statistical basis for the identification of and intervention for high-risk populations.MethodsA retrospective study of 312 first renal allograft recipients was conducted between January 2015 and March 2022. The covariates were screened using univariable time-dependent Cox regression, and those with P<0.1 were included in the dynamic and static analyses. We constructed a prediction model for BKV reactivation from 2.5 to 8.5 months after renal transplantation using dynamic Cox regression based on the landmarking method and evaluated its performance using the area under the curve (AUC) value and Brier score. Monte-Carlo cross-validation was done to avoid overfitting. The above evaluation and validation process were repeated in the static model (Cox regression model) to compare the performance. Two patients were presented to illustrate the application of the dynamic model.ResultsWe constructed a dynamic prediction model with 18 covariates that could predict the probability of BKV reactivation from 2.5 to 8.5 months after renal transplantation. Elder age, basiliximab combined with cyclophosphamide for immune induction, acute graft rejection, higher body mass index, estimated glomerular filtration rate, urinary protein level, urinary leukocyte level, and blood neutrophil count were positively correlated with BKV reactivation, whereas male sex, higher serum albumin level, and platelet count served as protective factors. The AUC value and Brier score of the static model were 0.64 and 0.14, respectively, whereas those of the dynamic model were 0.79 ± 0.05 and 0.08 ± 0.01, respectively. In the cross-validation, the AUC values of the static and dynamic models decreased to 0.63 and 0.70 ± 0.03, respectively, whereas the Brier score changed to 0.11 and 0.09 ± 0.01, respectively.ConclusionDynamic Cox regression based on the landmarking method is effective in the assessment of the risk of BKV reactivation in the early period after renal transplantation and serves as a guide for clinical intervention.

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Incidence and risk factors for high-level BK viruria: a single center study in China

Cited by 7 publications

References 17 publications

Correlation between donor acute kidney injury and recipient BK viruria after surgery

Correlation between donor acute kidney injury and recipient BK viruria after surgery

BK Virus-Associated Nephropathy after Renal Transplantation

Dynamic risk prediction of BK polyomavirus reactivation after renal transplantation

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