Prospective BK Virus Screening in the Early Post-Kidney Transplant Period: A Single Center Experience
1UC Med Ctr, Cincinnati, OH, 2U Cincinnati, Cincinnati, OH
Meeting: 2019 American Transplant Congress
Abstract number: C256
Keywords: Kidney transplantation, Monitoring, Polyma virus
Session Information
Session Name: Poster Session C: Kidney: Polyoma
Session Type: Poster Session
Date: Monday, June 3, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: BK virus screening protocols for the early (up to post-transplant day 90) post kidney transplant (KT) period vary amongst kidney transplant centers. Most commonly, some centers test monthly for the first 3 months while others begin testing at 3 months. We describe outcomes of our plasma BK virus screening protocol beginning at 3 months.
*Methods: Starting in 2016 at University of Cincinnati Medical Center, we implemented a prospective plasma BK virus screening protocol in KT recipients starting at post-transplant day (PTD) 90 (PTD 90-365: every 3 months; PTD 365-730: every 6 months). For cause (acute kidney injury, rejection, hematuria, ureteral obstruction, etc.) plasma BK testing was done at any time point.
*Results: (See Table 1) Of 260 total KT recipients, 242 were screened for BK viremia (BKV) at or before PTD 90. 99 of these KT recipients had for cause BK testing before PTD 90, while the remaining 143 patients were not tested until PTD 90. The most frequent reason for early screening (n=88/99) was AKI (unexplained rise in serum creatinine >15% over baseline). 8 of 99 patients tested for cause (8.1%) had detectable BK viremia (BKV) at median PTD 31.5. At routine PTD 90 screening, 17 additional cases of BKV were discovered (total BKV 25). Mean BK titer in patients tested for cause was 6701, while it was 48,926 in those not checked until PTD 90. 3 of 25 pts who developed BKV had received prior enhanced immunosuppressive treatment for acute rejection or lupus flare. 3 of the 25 BKV patients (including 1 of the 3 with enhanced immunosuppression) subsequently demonstrated allograft biopsy-proven BK nephropathy (BKN) without rejection. 2 of these BKN patients were detected at the PTD 90 screen while one was screened for cause on PTD 62. All three patients maintain functioning grafts with most recent observed serum creatinines of 2.16, 2.12 and 1.35 mg/dL (16, 12, and 7 months post-Tx, respectively).
*Conclusions: BK viremia may happen much earlier in the post-transplant period (before PTD 90) especially in presence of enhanced immunosuppression. More frequent and early prospective screening of BKV in high-risk patients may result in early diagnosis, intervention and potentially prevent graft injury and loss.
| PTD 90 Screening | For cause prior to PTD 90 | |
| Total [N] | 143 | 99 |
|
BK viremia detected at ≤ 3 months [N(% of all BKV)] |
17 (11.9%) | 8 (8.1%) |
| BK Quant level when positive at ≤ 3 months [mean(SD)] | 48926 (108375) | 6701 (13549) |
| BK viremia in setting of any immunosuppression intensification [N(%) of all BKV)] | 2 (11.8%) | 1 (12.5%) |
| Biopsy proven BK nephropathy [N(% of all BKV)] | 2 (11.8%) | 1 (12.5%) |
To cite this abstract in AMA style:
Parrish N, Stander S, Anand M, Jawdeh BGAbu, Govil A. Prospective BK Virus Screening in the Early Post-Kidney Transplant Period: A Single Center Experience [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/prospective-bk-virus-screening-in-the-early-post-kidney-transplant-period-a-single-center-experience/. Accessed November 22, 2024.« Back to 2019 American Transplant Congress