The purpose of this study was to ascertain the prevalence and clinical implications of three of the most relevant opportunistic infections in kidney transplantation, namely BK virus (BKV), Cytomegalovirus (CMV) and Epstein-Barr virus (EBV).

With that purpose, in a large prospective multicenter study, 3797 blood samples from 541 kidney transplant recipients were analyzed for BKV, CMV, and EBV load by qPCR. The measurements were performed throughout eight visits during the first posttransplantation year. Clinical characteristics, including glomerular filtration rate, were collected in parallel.

We found that 260, 92 and 109 patients had a detectable BKV, CMV and EBV load, respectively. 72% of BKV⁺, 87% of CMV⁺ and 74% of EBV⁺ patients had cleared viremia one year posttransplantation. BKV⁺ and CMV⁺ patients had an impairment of renal function: in comparison to non-infected, patients with viremia (BKV > 2000 copies/mL or CMV > 8000 copies/mL) showed a significant (P = 0.04) GFR decline 1-year posttransplantation. Additionally, 57 patients were BKV⁺CMV⁺; the infections were significantly associated (P = 0.003). Coinfected patients did not have higher viremia than monoinfected and did not show more rejection episodes. However, even at lower thresholds (BKV > 1000 copies/mL and CMV > 4000 copies/mL) than for monoinfected patients, coinfected patients showed a deeper significant decrease in GFR of 9.2 mL/min one year posttransplantation (P = 0.04) when compared to the rest of the population. Regarding EBV, a significant association (P = 0.02) was found with CMV. This was not linked to significantly lower graft function. Interestingly, EBV viremia at over 1000 copies/mL was found to be associated with acute rejection. Remarkably, this was not the case for BKV; in the case of CMV, only high viremia (> 10000 copies/mL) were associated to rejection.

Our results demonstrate the significance of BKV and CMV coinfection for the long-term allograft function and highlight the importance of a good therapeutic monitoring and control of the viral reactivations, even at low viremia levels.

CITATION INFORMATION: Blázquez-Navarro A, Dang-Heine C, Or-Guil M, Bauer C, Westoff T, Hugo C, Reinke P, Sawitzki B, Babel N. BK Virus, Cytomegalovirus and Epstein-Barr Virus Reactivation in Renal Transplant Patients: Results from a Large Multicenter Study. Am J Transplant. 2017;17 (suppl 3).

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