Polyomavirus-associated nephropathy risk in kidney transplants: the influence of recipient age and donor gender

Abstract

Polyomavirus-associated nephropathy (PVAN) is a frequent cause of kidney transplant failure. We determined the risk factors for biopsy-proven PVAN among 1027 recent kidney transplant recipients by univariate and multivariate analyses. The rate of PVAN was determined over an univariate and multivariate analysis over an average of 30 months of follow-up of patients receiving predominantly living donor grafts with antibody induction and sequential surveillance biopsies to detect subclinical graft disease. Seventy-four transplant recipients were diagnosed with PVAN with the finding made on surveillance biopsy in 40 patients. These 40 cases did not differ from the 34 non-surveillance cases with respect to baseline clinical characteristics or initial histological features. Older recipient age and female donor gender were independent risks associated with PVAN. Factors not linked to PVAN risk included the use and type of induction agent, use of tacrolimus vs sirolimus, the number of human lympocyte antigen (HLA) mismatches, or the frequency of acute rejection. We conclude that PVAN preferentially affects older age patients and allografts from female donors but is unrelated to immunological risk, choice of immunosuppression, or rejection history.

Identifying Specific Causes of Kidney Allograft Loss

“…There is evidence that these drugs may contribute to the production of the allograft fibrosis (20,27 (20) particularly in high-risk recipients (28). Overall, the findings of this study highlight the fact that the term IF/TA (or CAN) should not be used as a diagnostic term to explain kidney graft loss (15,29).…”

Inhibition of Polyomavirus BK-Specific T-Cell Responses by Immunosuppressive Drugs

“…The average adult KT patient population is older with median age close to 50 years and a more pronounced net state of immunosuppression. In fact, older age and TAC trough levels greater than 8 ng/mL have been previously implicated as risk factors for PVAN (25)(26)(27). The retrospective analysis by Cosio et al (28) indicated that low-dose TAC may be a successful strategy to prevent BKV replication and disease in KT patients.…”

Changing Kidney Allograft Histology Early Posttransplant: Prognostic Implications of 1-Year Protocol Biopsies

“…Specifically, in response to a high incidence of PVAN tacrolimus doses were reduced starting in 2002 and this was associated with significant reductions in PVAN, better graft function, and less allograft fibrosis at 1 year (31). Additional declines in PVAN followed avoidance of T cell depleting induction in recipients older than 65, a particularly vulnerable group for this infection (32). An unintended consequence of the reduction in PVAN was a reduction in acute rejection because treatment of PVAN requires reductions in immunosuppression that increases risk of rejection.…”