Monthly screening for BK viremia is an effective strategy to prevent BK virus nephropathy in renal transplant recipients

Alméras, Cyrielle; Vetromile, Fernando; Garrigue, V.; Szwarc, Ilan; Foulongne, Vincent; Mourad, Georges

doi:10.1111/j.1399-3062.2011.00619.x

Cited by 71 publications

(72 citation statements)

References 25 publications

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“…Although a pediatric prospective cohort reported by Hymes et al reported a mean time of BKV viremia of 90 months [11], recent reports of adult populations have found most of the cases occurring in the 1st months after transplantation, with a median time for viremia of 75e90 days [14,15]. This timing is supported by our experience and other pediatric series, such as that of the Italian group of Ginevri et al [13], who reported a median time for viremia of 3 months.…”

Section: Discussionsupporting

confidence: 80%

BK Virus Infection in Pediatric Renal Transplantation

Santoveña

Meseguer

Mejía

et al. 2015

Transplantation Proceedings

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Section: Discussionsupporting

confidence: 80%

BK Virus Infection in Pediatric Renal Transplantation

Santoveña

Meseguer

Mejía

et al. 2015

Transplantation Proceedings

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“…Almost one half of the patients with BKviremia were identified at the 3-month screening time point, consistent with other reports. 3,4,14 In contrast to some prior studies, 7,8,14 our multivariate analysis did not find an association between development of BK and choice of induction or maintenance immunosuppression; however, this result may be because of the overwhelmingly predominant use of rATG induction and tacrolimus-mycophenolate-based immunosuppression in our cohort. Other previously identified risk factors, 9,10,20,21 such as sex, race, and ureteral stent use, were not shown to be significantly associated with BK viremia in our cohort.…”

Section: Discussioncontrasting

confidence: 56%

“…2 Although seldom a concern in immunocompetent hosts, BK viremia may be detected in 10%-30% of kidney recipients. [3][4][5] The best elucidated risk factor for BK virus infection in kidney recipients is the overall degree of immunosuppression, with lymphodepleting antibody induction as well as tacrolimus-and mycophenolic acid (MPA)-based regimens considered by some to be especially permissive. [6][7][8] If untreated, BKviremia can progress to BK nephropathy, impaired allograft function, and graft loss.…”

mentioning

confidence: 99%

Persistent BK Viremia Does Not Increase Intermediate-Term Graft Loss but Is Associated with De Novo Donor-Specific Antibodies

Sawinski¹,

Forde²,

Trofe‐Clark³

et al. 2015

Journal of the American Society of Nephrology

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There are limited data regarding intermediate-term outcomes in patients with persistent BK viremia. Other viral infections have been implicated in the development of allosensitization through heterologous immunity, but the relationship between BK viremia and donor-specific antibodies (DSAs) is unexplored. In 2008, we initiated routine post-transplant BK viremia and DSA screening at our center; 785 kidney or kidney-pancreas transplant recipients were included in our study. Of these recipients, 132 (17%) recipients developed BK viremia during the study period. The median duration of BK viremia was 140 days (interquartile range=40-393 days), and persistent BK viremia was defined as lasting $140 days. Kaplan-Meier curves were generated to assess differences in patient and allograft survival on the basis of BK viremia status; survival was modeled using Cox proportional hazard regression. After a median follow-up of 3 years, there was no significant difference in terms of patient (hazard ratio [HR], 0.83; 95% confidence interval [95% CI], 0.28 to 2.49) or allograft survival (HR, 0.80; 95% CI, 0.37 to 1.73) between patients with and without BK viremia, which was confirmed in a time-varying analysis. In our logistic regression model, persistent BK viremia was strongly associated with the development of class II (HR, 2.55; 95% CI, 1.30 to 4.98) but not class I (HR, 1.13; 95% CI, 0.46 to 2.77) DSAs. These data suggest that persistent BK viremia does not negatively affect intermediate-term patient or allograft survival but is associated with increased risk for de novo DSA, although the exact mechanism is unclear.

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“…In a study by Yelken et al [15] investigating BKVAN in patients with renal transplant, BKVAN was detected in 11 (2.7%) of 412 patients, graft loss developed in two of three patients with acute rejection and kidney functions of other patients returned to baseline values. Almeras et al [17] monitored the BKV DNA values in 119 renal transplant recipients with 6-month intervals, BK viraemia was detected in 13 patients (10.9%); in 11 patients, viraemia became negative with reduction of immunosuppressive dose, one patient had decreased levels and one patient (0.8%) had increased levels and developed graft rejection. In the same study, it was reported that 77% of patients developed viraemia within four months after transplantation [17] .…”

Section: Discussionmentioning

confidence: 99%

“…Almeras et al [17] monitored the BKV DNA values in 119 renal transplant recipients with 6-month intervals, BK viraemia was detected in 13 patients (10.9%); in 11 patients, viraemia became negative with reduction of immunosuppressive dose, one patient had decreased levels and one patient (0.8%) had increased levels and developed graft rejection. In the same study, it was reported that 77% of patients developed viraemia within four months after transplantation [17] . In this study, BK viraemia developed in 12 of 118 patients, while BKVAN in three patients (2.5%); one of the patients was within the first 6-month period after transplantation and two of them were in the >12-month period.…”

Section: Discussionmentioning

confidence: 99%

The Impact of BK Virus and Cytomegalovirus Infections on Graft in Renal Transplant Patients: Experience of a Tertiary Hospital in Turkey

Köse¹,

Atalay²,

Ulu³

et al. 2018

mjima

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Introduction: BK virus (BKV) and cytomegalovirus (CMV) infections are common in renal transplant patients. In this retrospective study, we investigated the frequency of BKV and CMV infections and their effects on graft. Materials and Methods:The data of 118 renal transplant recipients who were transplanted and followed-up between January 2010 and January 2011 were reviewed. Demographic characteristics, biochemical data, BKV and CMV DNA levels by polymerase chain reaction (QIAGEN, Hilden, Germany) were investigated. The patients were followed-up monthly in the first six months and then every three months. Results: A total of 118 patients were included in the study. BK viraemia was detected in 12 (10.2%) patients and the DNA level of BKV was >10 4 copies/mL in five cases. Three patients with elevated creatinine and compatible renal biopsy findings were considered to have BKV-associated nephropathy (BKVAN). With the reduction of immunosuppressive treatment, viraemia was reduced and creatinine levels decreased within normal levels. Cytomegalovirus DNA was found to be positive in 23 (19.5%) patients, and was >500 copies/mL in 4 (3.4%) patients. The viraemia in these four patients has decreased after antiviral therapy. No CMV related disease were found in any of the patients. Cytomegalovirus DNA positivity at low levels were also detected in three patients who were diagnosed with BKVAN. None of the patients developed rejection. Conclusion: BK and CMV infections in kidney transplant patients are common and can be seen together. However, graft dysfunction and rejection rates are low with close monitoring, early diagnosis and treatment. Randomized, controlled studies with larger patient groups are necessary in order to determine the viral threshold levels associated with graft dysfunction or rejection, to decide the optimal management and to explain the role of concomitant infection. Keywords: BK, kidney, transplantation, infection, ciprofloxacinGiriş: BK virüs (BKV) ve sitomegalovirüs (CMV) enfeksiyonları böbrek nakli hastalarında yaygın olarak görülür. Bu retrospektif çalışmada BKV ve CMV enfeksiyon sıklığı ve greft üzerine etkileri araştırılmıştır. Gereç ve Yöntem: Ocak 2010 ve Ocak 2011 tarihleri arasında böbrek nakli uygulanan ve takip edilen 118 böbrek nakil alıcısının verileri retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, biyokimyasal veriler ve polimeraz zincir reaksiyonu (QIAGEN, Hilden, Germany) yöntemiyle BKV ve CMV DNA seviyeleri araştırıldı. Hastalar önce altı ay aylık olarak, daha sonra üç aylık periyotlarla izlenmiştir. Bulgular: Çalışmaya toplam 118 hasta alınmıştır. BK viremisi 12 (%10,2) hastada saptanmış olup, beş olguda BKV DNA düzeyi >10 4 kopya/mL olarak tespit edilmiştir. Kreatinin yüksekliği de olan ve biyopsi bulguları uyumlu bulunan üç hasta, BKV ile ilişkili nefropati olarak değerlendirilmiştir. İmmünsüpresif tedavinin azaltılması ile viremi gerilemiş ve kreatinin seviyeleri normal düzeye gelmiştir. Sitomegalovirüs DNA, 23 (%19,5) hastada pozitif, dördünde (%3,4) ise >...

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Monthly screening for BK viremia is an effective strategy to prevent BK virus nephropathy in renal transplant recipients

Abstract: BKV infection is an early complication. Monthly NAT in blood during the first 6 months and immediate reduction of IS in viremic patients almost completely prevent definitive BKVN.

Cited by 71 publications

References 25 publications

BK Virus Infection in Pediatric Renal Transplantation

BK Virus Infection in Pediatric Renal Transplantation

Persistent BK Viremia Does Not Increase Intermediate-Term Graft Loss but Is Associated with De Novo Donor-Specific Antibodies

The Impact of BK Virus and Cytomegalovirus Infections on Graft in Renal Transplant Patients: Experience of a Tertiary Hospital in Turkey

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