Infections have increased in simultaneous pancreas/kidney transplant recipients (SPKTRs) with BKV-associated nephropathy (BKVN) being the most important infectious cause of allograft loss. Comparisons of BKVN with kidney transplant recipients (KTRs), however, are lacking.

We studied all KTRs and SPKTRs at our transplant center between 2003 and 2012. 24 of 1098 KTRs (2.2%) and 11 of 106 SPKTs (10.4%) were diagnosed with BKVN with allograft loss in 3 KTRs (12.5%) and 1 SPKTR (9.1%). A control of 95 SPKTRs without BKVN was used for comparison.

SPKTRs showed an increased incidence of BKVN compared to KTRs (p<0.001). Onset of BKVN in SPKTRs was significantly later compared to KTRs (p=0.044). While 67% of KTRs showed early-onset BKVN, 64% of SPKTRs developed late-onset BKVN. Older recipient age and male gender increased the risk of BKVN in SPKTRs (p<0.05). No differences were observed for patient and allograft survival (p>0.05). However, SPKTRs with BKVN showed inferior estimated GFR and a higher incidence of de novo donor-specific antibodies compared to SPKTRs without BKVN in long-term follow-up (p<0.05). SPKTRs showed higher peak BKV-loads, need for more intense therapeutic intervention, and were more likely not to recover to baseline creatinine after BKVN (p<0.05).

Our results suggest a higher incidence, more severe course, and inferior outcome of BKVN in SPKTRs. An increased vulnerability of the allograft kidney due to inferior organ quality may predispose KTRs to early-onset BKVN. In contrast, SPKTRs present with late-onset BKVN in the presence of high-dose immunosuppression.

CITATION INFORMATION: Schachtner T, Zaks M, Kahl A, Reinke P. Simultaneous Pancreas/Kidney Transplantation Increases the Risk of Late-Onset BKV-Associated Nephropathy. Am J Transplant. 2016;16 (suppl 3).

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