BK-virus-associated nephropathy (BKVAN) can cause kidney-allograft dysfunction after kidney transplantation: several risk factors for BKV replication after kidney transplantation have been identified. They can be related to the recipients' characteristics, to the posttransplant course and immunosuppressive therapy, or to the donors' characteristics. The aims of our study were to investigate the impact of donors shedding BKV and its replication during the first year posttransplant in a cohort of living-kidney donors and their paired recipients, and to identify risk factors for BKV replication.

121 patients who had undergone living-donor kidney transplantations were included in this retrospective study. All donors and recipients were tested before transplantation for BK viremia and viruria. After transplantation, urine and blood from all kidney-transplant patients were screened for BKV on day 15 and at months 1, 3, 6, 9, and 12 post-transplantation, as well as each time they presented with impaired kidney function.

During the first year post-transplantation, 33 (27.3%) recipients developed BK viruria, 15 (12.4%) recipients developed BK viremia. and only one developed BKVAN (0.8%). The mean times between transplantation and first BK viruria and viremia were 4.3±4.3 and 4.3±2.6 months, respectively. Ten donors of 121 (8.3%) had BKV replication in the urine before transplantation. None had BK viremia. Overall, 33 recipients developed BK viruria after transplantation: 7 had received a kidney from a donor with BK viruria (7 of the 10 positive donors, 70%), and 26 had received a kidney from a donor without BK viruria (26 of the 111 negative donors, 23%), p= 0.0015. Fifteen recipients developed BK viremia after transplantation: 3 had received a kidney from a donor with BK viruria (3 of 10 positive donors, 30%), and 12 had received a kidney from a donor without BK viruria (12 of 111 negative donors, 11%), p= 0.08. At pretransplant, donors' BKV shedding was an independent predictive risk factor for BKV replication after kidney transplantation (OR 6.53, CI50% 1.46-29.28, p=0.01).

Hence, screening living kidney donors for BKV enabled identification of patients at high risk of BKV replication after transplantation and to adapt immunosuppression accordingly.

CITATION INFORMATION: Grellier J, Del Bello A, Esposito L, Hebral A, Mengelle C, Kamar N. Impact of Donor BK-Virus Replication on Posttransplant BKV Replication After Living-Donor Transplantation. Am J Transplant. 2017;17 (suppl 3).

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