Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background: Identification of risk factors for the long-term outcome of BK virus (BKV) -associated nephropathy(BKVAN) may improve renal transplant outcome. Methods: Between 2006 and 2014, renal transplant graft biopsies combined with BKV screening were performed in 621 patients. A total of 45 (7.2%) cases of BKVAN were diagnosed by simian virus 40 staining. 45 patients were treated with immunosuppressant reduction and were monitored for BKV every 1-4 weeks during the follow-up. Results: At diagnosis(14.7±6.5months post transplant), the median level of urinary decoy cells, viruria, viremia were 15/10HPF, 8.7 ×108 copy/ml, and 4.6×104 copy/ml, respectively. Serum creatinine was 195.3± 119.5¯o;mol/L. We either reduced cyclosporine A by 30%(n=1), or reduced tacrolimus(Tac) by 30%-50%(n=22), or switched from Tac to cyclosporine A (n=19), or switched from Tac to Rapamycin(n=3). During 40.5 ± 25.3 months follow-up, the patients were divided into 4 groups according to the response to the immunosuppressant reduction: i. graft short-term(3 months after diagnosis) functional decline(n=12,26.7%), ii. long-term functional decline(n=14,31.1%), iii. graft loss(n=11,24.4%), and iv. graft functional stabilization or improvement(n=8, 17.8%). In group i., the median level of the three screening tests at diagnosis was the highest(34/10HPF, 9.8 ×109 copy/ml, and 6.6×105 copy/ml, respectively) among the 4 groups(all p<0.05); viral reduction[the time for viral PCR reduction in plasma by 1 log(90%)]was 5.2±2.5months, which was slower than that of group ii(3.3 ±1.2months) and iv(2.4 ±0.9months)(p<0.05). After long-term follow-up, in group iv., serum creatinine was 135.3± 29.5¯o;mol/L, which was lower than that of group i(465.3± 126.7¯o;mol/L) and ii(233.4± 79.6¯o;mol/L (all differences p<0.05). All 8 patients in group iv cleared viremia(mean time: 5.1 ±1.2months). The frequency of viruria clearance of group iv(50%) was higher than that of group i(12.3%) and ii(33.6%), respectively(p<0.05). Multivariate Cox model analysis showed that the histological patterns (RR 6.2, p=0.010) at diagnosis and viral reduction of viremia (RR 20.3, p=0.009) were associated with graft long-term survival. Conclusions: The histological patterns at diagnosis and viral reduction time influence long-term graft survival in patients with BKVAN.
To cite this abstract in AMA style:Huang G, Wang C-X, Fei J-G, Qiu J, Deng S-X, Li J, Chen G-D, Fu Q, Deng R-H, Chen L-Z. Correlates of Clinical Course of Polyomavirus BK Infection With Long-Term Outcome of BK Virus-Associated Nephropathy in Renal Transplant Patients [abstract]. Am J Transplant. 2015; 15 (suppl 3). http://atcmeetingabstracts.com/abstract/correlates-of-clinical-course-of-polyomavirus-bk-infection-with-long-term-outcome-of-bk-virus-associated-nephropathy-in-renal-transplant-patients/. Accessed September 24, 2017.
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