Prevalence, Risk Factors, Treatment, and Overall Impact of BK Viremia on Kidney Transplantation

Malik, Omar; Saleh, Sherif; Suleiman, Belal; Ashqar, Bilal; Maibam, Amita; Yaseen, Maria; Elrefaei, Amro; Hines, Abigail E.; Cornea, Virgilius; El-Husseini, Amr; Mei, Xiaonan; Gedaly, Roberto; Castellanos, Ana Lia; Waid, Thomas

doi:10.1016/j.transproceed.2019.03.035

Cited by 19 publications

(18 citation statements)

References 32 publications

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“…26,27 Conversely, studies have demonstrated inferior patient and graft survival in KTRs who developed BK viremia. 28 Our study supports the former of these findings, while also taking them one step further with the suggestion that BK viremia in the absence of BKN may lead to not only standard outcomes but possibly even superior outcomes due to associated risk reduction.…”

Section: Discussionsupporting

confidence: 85%

Risk factors and outcomes of BK viremia among deceased donor kidney transplant recipients based on donor characteristics

Breyer

Dodin

Djamali

et al. 2021

Transplant Infectious Dis

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Introduction: BK polyomavirus (BKV) is a common infection among kidney transplant recipients (KTR). Risk factors and outcomes based on donor characteristics remain largely unknown. Methods:In this study, we aimed to analyze the impact of donor factors through a paired kidney analysis. We included 289 pairs of adult deceased donor transplants (578 KTRs total); each pair had received kidneys from the same donor. Recipient pairs were divided into three groups: "no BK group" if neither KTR developed BK viremia (n = 336), "discordant" if the only one did (n = 176), and "concordant" if both did (n = 66).Acute rejection (AR), graft failure, and BK nephropathy (BKN) were outcomes of interest.Results: Donors in the concordant group were younger, had lower kidney donor profile index (KDPI), and were less likely to be donor after circulatory death (DCD). In multivariate analyses, KTRs who had a donor with a higher body mass index (BMI)

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Section: Discussionsupporting

confidence: 85%

Risk factors and outcomes of BK viremia among deceased donor kidney transplant recipients based on donor characteristics

Breyer

Dodin

Djamali

et al. 2021

Transplant Infectious Dis

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“…Each center retrospectively identified adult renal allograft recipients (≥18 years) with a biopsy proven diagnosis of “definitive” polyomavirus nephropathy: Cornell N = 30, UNC N = 54, and Kentucky N = 15 patients, total n = 99 post exclusion (see below). Some patients from Kentucky were included in a previous publication 13 . All patients were transplanted after January 1, 2009 and managed locally according to center‐specific standard of care guidelines.…”

Section: Methodsmentioning

confidence: 99%

The 2018 Banff Working Group classification of definitive polyomavirus nephropathy: A multicenter validation study in the modern era

Nickeleit

Singh

Dadhania

et al. 2021

American Journal of Transplantation

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Polyomavirus nephropathy (PVN) remained inadequately classified until 2018 when the Banff Working Group published a new 3‐tier morphologic classification scheme derived from in‐depth statistical analysis of a large multinational patient cohort. Here we report a multicenter “modern‐era” validation study that included 99 patients with definitive PVN transplanted post January 1, 2009 and followed the original 2018 study design. Results validate the PVN classification, that is, the 3 PVN disease classes predicted clinical presentation, allograft function, and outcome independent of therapeutic intervention. PVN class 1 compared to classes 2 and 3 was diagnosed earlier (16.9 weeks posttransplant [median], P = .004), and showed significantly better function at 24 months postindex biopsy (serum creatinine 1.75 mg/dl, geometric mean, vs class 2: P = .037, vs class 3: P = .013). Class 1 presented during long‐term follow‐up with a low graft failure rate: 5% class 1, vs 30% class 2, vs 50% class 3 (P = .009). Persistent PVN was associated with an increased risk for graft failure (and functional decline in class 2 at 24 months postdiagnosis; serum creatinine with persistence: 2.48 mg/dL vs 1.65 with clearance, geometric means, P = .018). In conclusion, we validate the 2018 Banff Working Group PVN classification that provides significant clinical information and enhances comparative data analysis.

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“…Recipient age was identified as a risk factor for BKPyV viremia with borderline significance (HR [per decade]: 1.40; P ‐value = .059). Previous studies have also found a weak, and often not significant, association between BKPyV infection and recipient age 21‐23 . Quite unexpectedly, the pre‐transplant diagnosis of coronary heart disease was associated with the occurrence of BKPyVAN (HR: 4.14; P ‐value = .040), although caution must be applied in drawing causal inference.…”

Section: Discussionmentioning

confidence: 94%

“…Cox regression models in different landmark analyses for the occurrence of BKPyV viremia according to various measurements of CMV infection and (V) GCV exposure over the preceding periods age. [21][22][23] Quite unexpectedly, the pre-transplant diagnosis of coronary heart disease was associated with the occurrence of BKPyVAN (HR: 4.14; P-value = .040), although caution must be applied in drawing causal inference. It may be speculated that this finding would reflect the negative systemic effect of the atherosclerotic inflammatory milieu.…”

Section: Ta B L E 2 Unadjusted and Adjustedmentioning

confidence: 99%

CMV infection, valganciclovir exposure, and the risk of BK viremia and associated nephropathy after kidney transplantation: Is there a link?

Rodríguez‐Goncer

Ruiz-Ruigómez

López‐Medrano

et al. 2021

Transplant Infectious Dis

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Background Immunomodulatory effects attributable to cytomegalovirus (CMV) would predispose to BK polyomavirus (BKPyV) infection after kidney transplantation (KT), although available evidence is conflicting. It has been suggested that (val)ganciclovir therapy may increase the risk of BKPyV viremia and BKPyV‐associated nephropathy (BKPyVAN) as a result of drug‐induced T‐cell impairment. Methods We investigated whether CMV replication and/or (val)ganciclovir exposure (either as prophylaxis or treatment) were associated with the development of BKPyV viremia or BKPyVAN in a prospective cohort of 399 KT recipients. CMV infection (any level or high‐level viremia and area under the curve of DNAemia) and (val)ganciclovir exposure (any duration of therapy and cumulative days of treatment) during the first post‐transplant year were explored through separate landmark survival analyses. Results Cumulative incidence of BKPyV viremia and BKPyVAN after a median follow‐up of 551 days was 23.1% and 2.5%, respectively. One‐year rates of CMV infection and (val)ganciclovir therapy were 47.4% and 54.1%, respectively. No differences were observed in BKPyV viremia‐ or BKPyVAN‐free survival according to previous CMV infection or (val)ganciclovir exposure in any of the landmark analyses. Adjusted Cox models confirmed this lack of association. Conclusion Our findings do not confirm the existence of a relevant impact of CMV infection or (val)ganciclovir therapy on the risk of post‐transplant BKPyV events.

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Prevalence, Risk Factors, Treatment, and Overall Impact of BK Viremia on Kidney Transplantation

Cited by 19 publications

References 32 publications

Risk factors and outcomes of BK viremia among deceased donor kidney transplant recipients based on donor characteristics

Risk factors and outcomes of BK viremia among deceased donor kidney transplant recipients based on donor characteristics

The 2018 Banff Working Group classification of definitive polyomavirus nephropathy: A multicenter validation study in the modern era

CMV infection, valganciclovir exposure, and the risk of BK viremia and associated nephropathy after kidney transplantation: Is there a link?

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