Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Polyoma virus associated nephropathy (PyVAN) caused by BK virus (BKV) is a major complication occurring in 1-10% of renal transplant recipients. Screening and reduction of immunosuppression (IS) at a BKV load of >4-log copies/ml is recommended along with adjunctive anti-virals. Rates of presumptive PyVAN (PP) were 10%-15% in recent studies that implemented IS reduction at >4-log copies/ml. We report on the incidence of PyVAN while implementing IS reduction at BKV loads of >3-log BKV copies/ml.
We performed a retrospective analysis of consecutive de-novo kidney-only transplants from January 2009 to December 2012. Recipient plasma was screened for BKV DNA via quantitative PCR at months 1, 3, 6, 9 and 12 post-transplant and on worsening graft function. IS was reduced for >3-log copies/ml. Those with viremia of >4-log copies/ml underwent renal transplant biopsy. PP and definitive PyVAN (DP) were treated by IS reduction only. Additional data were collected to identify risk factors for PyVAN.
Among 330 recipients, median age was 53 years (range 19-83), 66% were male, 59% were white, and 54% had a deceased-donor kidney transplant (DDKT). The IS regimen included both a calcineurin inhibitor and mycophenolate in 95% and 5% were steroid-free. Biopsy-proven rejection was found in 19% within 0-168 weeks. 319 underwent BKV screening.
BK viremia of >3-log copies/ml was detected in 63 (20%) recipients, of which 47 (15% of those screened) were diagnosed with PP (median time: 25 weeks). Biopsy was performed in 34, and 18 (6% of those screened) were then diagnosed with DP. Two patients progressed to graft failure and 4 developed acute rejection (AR) within 90 days after IS reduction. DDKT (OR=2.3; 95% CI=1.1-4.6) and AR (OR=2.3; 95% CI=1.2-4.7) were associated with PyVAN in multivariate analysis.
BK viremia between 3 and 4-log copies/ml occurred in 27 patients, all of whom underwent reduction of IS. Of these, 16 (59%) never developed PyVAN while 11 (41%) developed PyVAN (4 DP, 7 PP) within 11-39 weeks.
The incidence of PyVAN was consistent with previously reported rates and was associated with DDKT and AR. In patients with BKV loads between 3 and 4-log copies/ml, only 41% eventually developed PyVAN. Reducing IS at a lower threshold of ≥3-log copies/ml may abrogate the development of PyVAN, but larger and controlled studies are needed to confirm this finding.
CITATION INFORMATION: Azar M, Valika A, Banach D, Hall I, Malinis M. Incidence of Polyoma Virus Associated Nephropathy in a Single Transplant Center Employing a Reduction of Immunosuppression at a Lower Threshold of BK Viremia. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Azar M, Valika A, Banach D, Hall I, Malinis M. Incidence of Polyoma Virus Associated Nephropathy in a Single Transplant Center Employing a Reduction of Immunosuppression at a Lower Threshold of BK Viremia. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/incidence-of-polyoma-virus-associated-nephropathy-in-a-single-transplant-center-employing-a-reduction-of-immunosuppression-at-a-lower-threshold-of-bk-viremia/. Accessed September 21, 2017.
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