Introduction:

BK polyoma virus associated nephropathy [BKVAN] is a major cause of allograft dysfunction and graft loss occurring in up to 10% of kidney allograft recipients with a mean time to diagnosis of 120 days. Although BKVAN is associated with a higher exposure to immunosuppressive agents, there are few reports describing the incidence and outcomes of BKVAN in patients receiving Alemtuzumab [Az] induction.

Methods:

1503 low risk kidney only transplant recipients received a steroid sparing regimen with Az induction and tacrolimus monotherapy or IL2RA induction with tacrolimus and MMF. BKVAN was only diagnosed by allograft biopsy [viral inclusions, tubular injury and interstitial infiltrates in the areas of tubular damage]. BKVAN was treated by MMF cessation and tacrolimus dose reduction.

Results:

68/1503 [4.5%] patients developed BKVAN. Patients receiving Az induction had a significantly lower incidence of BKVAN 50/1503 [3.81%] compared with patients receiving IL2R induction 18/192 [9.4%, p= 0.0005]. Mean time to development of BKVAN was 370 days. Mean death censored allograft survival was 7.47 + 0.55 years for both groups. However censored allograft survival was superior in those patients on MMF at the time of BKVAN diagnosis compared to CNIs alone [p=0.023]Discussion:

Induction with Az is associated with a lower incidence of BKVAN compared with IL2RA. Patients with BKVAN on MMF at diagnosis had better allograft survival, presumably because we were able to stop MMF.

CITATION INFORMATION: Gueret-Wardle A, Hassan S, Lucisano G, Roufosse C, Willicombe M, Taube D. Alemtuzumab Induction Is Associated with a Lower Incidence of BK Virus Nephropathy Compared with IL2RA Induction. Am J Transplant. 2017;17 (suppl 3).

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