Introduction: BK virus (BKV) continues to impact renal transplant recipients (RTR). The New England BK Consortium was formed to unite the leadership of 14 transplant centers within UNOS Region 1 to jointly optimize screening and management of BKV infections.

Methods: Our 1^st project was to survey centers' BKV protocols and compare them to consensus guidelines (CG) published by the AST in 2013.

Results: Thirteen centers (92.9%) shared their data. The CG suggest screening either urine (viruria/decoy cells) or plasma (viremia) for BKV. Ten centers perform initial screening using plasma, and 3 centers screen urine. One screening protocol recommended by the CG calls for monthly plasma BKV screening for the first 6 months, then every 3 months until 2 years posttransplant. Among our centers, 1 uses this CG recommendation, 4 centers use a more intensive screening method, while 8 report less intensive methods. Two centers screen for a 2-year period, but 5 centers report a longer duration and 6 centers report a shorter duration. The estimated percentage of patients that undergo full screening at all centers is 81.2+19.3%.

The CG propose immunosuppression (IS) reduction in RTR with sustained plasma BKV viral loads or biopsy-proven polyomavirus-associated nephropathy (PyVAN). Our centers reduce IS when patients' viral loads exceed a certain threshold (median threshold >750 copies/ml). At 1 center, renal biopsies are performed in all patients with plasma viral loads >10,000 copies/ml, while all other centers only perform biopsies in RTR with persistent viremia and stagnant/worsening renal function. For presumptive PyVAN, 11 centers recommend a biopsy for confirmation, while 2 centers further reduce IS or use leflunomide. For management of documented PyVAN, 12 centers propose further IS reduction and 1 center recommends IVIG. Nine centers report CNI dose reduction as their primary treatment. Eight centers report using leflunomide for persistent viremia/PyVAN, 4 centers consider using cidofovir for worsening viremia, while 8 centers consider using IVIG for persistent viremia, or rejection with BKV viremia/PyVAN.

Conclusions: There was a large variance in BKV screening and management strategies among our centers. We plan to implement uniform screening and management protocols across all participating center.

CITATION INFORMATION: Gabardi S, Pavlakis M, Tan C, Francis J, Cardarelli F, Asch W, Bodziak K, Chobanian M, Gilligan H, Gohh R, Kung S, Inker L, Martin S, Rodig N, Rossi A, Chandraker A. New England BK Consortium: Regional Survey of BK Screening and Management Protocols in Comparison to Published Consensus Guidelines. Am J Transplant. 2016;16 (suppl 3).

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