BK virus nephropathy is an important cause of kidney allograft dysfunction, and the mainstay of management is reduction of immunosuppression. In recipients of multiorgan transplants, including simultaneous pancreas-kidney transplants (SPK), there is concern that lowering immunosuppression may lead to rejection/loss of the non-renal allograft. Herein, we aim to review the outcomes associated with this strategy in a cohort of SPK patients.

Methods:

This is a single center retrospective review of 31 consecutive adult SPK recipients who were transplanted in the first 4.5 years following the adoption of a serum BK PCR screening protocol. This protocol was adopted in January 2011 and included serial BK screening at weeks 4,6,8,10,12, and then at months 4,5,6,9,12,24,and 36. BK viremia above 500 copies/ml was managed with reduction of immunosuppression.

Results:

All patients received induction with either thymoglobulin or basiliximab, and all received initial maintenance immunosuppression with tacrolimus, mycophenolate and prednisone. BK viremia occurred in 11/31 (35.5%) of SPK recipients at a median 112 days following transplant. We did not identify any risk factors associated with the development of BK viremia. BK viremia was managed solely with reduction of immunosuppression. On average, mycophenolate dose was reduced by 25% and tacrolimus trough decreased by 2.1 ng/dl from the time of diagnosis to the time of clearance. 2/11 patients with BK viremia developed biopsy-proven BK virus nephropathy, but there were no graft losses from BKVN. Following reduction of immunosuppression, 3/11 patients developed mild acute cellular rejection of the kidney allograft, but treatment course was not altered. There have been no kidney allograft losses due to rejection or BK nephropathy. Two patients (18%) developed acute cellular rejection of the pancreas following reduction of immunosuppression. Both of these were treated with pulse steroids, and both grafts retained function. Patient survival in subjects with BK viremia at any time was 10/11, with one death due to systemic infection (both organs were functioning at the time of death). Patient survival was 85% in the SPK recipients who did not develop BK viremia, not significantly different from the BK+ group.

Conclusion:

SPK recipients screened for BK virus by serum PCR, and managed with reduction of immune suppression, experienced acceptable rates of rejection of both allograft types. The overall patient and graft survival was not lower than BK negative patients.

CITATION INFORMATION: Westphal S, Miles C. BK Viremia Surveillance and Management in Simultaneous Pancreas-Kidney Transplants. Am J Transplant. 2016;16 (suppl 3).

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