Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-6:05pm
*Purpose: Transplantation of kidneys from deceased donors with hepatitis C virus (HCV) infection into HCV-negative recipients has become more common, but some studies have suggested elevated risks of immunological complications such as BK polyomavirus (BKPV). Prior studies have generally been limited by single-center populations, low granularity data and/or no comparator group.
*Methods: We assembled a retrospective cohort of adult HCV-negative recipients of HCV-viremic kidneys and recipients of HCV-aviremic kidneys receiving care at four centers (COAUTHOR consortium: UPenn, MGH, Vanderbilt, Methodist Hospital) with regular screening for BKPV infection. We used optimal matching with variable number of controls, where each HCV-viremic kidney recipient could be matched to at least one and a maximum of five comparators. Recipients were matched on risk factors for BKPV viremia, including induction therapy, as well as allocation KDPI. The primary outcome was BKPV viremia ≥ 1,000 copies/mL or biopsy-proven BKPV nephropathy in the first post-transplant year. Outcomes were analyzed using Cox regression, weighted and stratified by matched set and expressed per 100 patient-years (PY).
*Results: The final matched cohort comprised 146 recipients of HCV-viremic kidneys and 453 matched comparators. HCV-viremic kidney transplantation was not associated with an elevated risk of BKPV viremia ≥ 1,000 copies/mL. HCV-viremic kidney transplantation had a non-significant association with the outcome of BKPV viremia ≥ 10,000 copies/mL; many of these infections took place at a center with delayed initiation of direct acting antiviral therapy. No biopsy proven BKPV nephropathy was observed. One year eGFR was clinically similar between groups. Only one HCV-viremic kidney transplant recipient had primary graft loss.
|BK >1,000 copies/mL||BKPV Viremia events||Patient-years of follow-up||Rate per 100 PY||Weighted Rate per 100 PY||Hazard Ratio (95% CI)|
|Donor HCV NAT-||68||381.9||17.8||22.2||1 (ref)|
|Donor HCV NAT+||33||125.8||26.2||26.2||1.15 (0.82, 1.61) p=0.42|
|BK >10,000 copies/mL|
|Donor HCV NAT-||41||396.8||10.3||13.3||1 (ref)|
|Donor HCV NAT+||25||128.6||19.4||19.4||1.48 (0.97, 2.24) p=0.07|
*Conclusions: HCV-viremic kidney transplantation was not associated with an elevated risk of BKPV viremia. While the data suggested the possibility that donor HCV conferred a higher risk of BKPV viremia ≥ 10,000 copies/mL associated with HCV, one year graft function outcomes for HCV-viremic recipients were reassuring.
To cite this abstract in AMA style:Potluri VS, Schaubel DE, Sise ME, Concepcion BP, Forbes RC, Blumberg EA, Goldberg D, Reese PP, Bloom R, Shaffer D, Chung R, Sawinski D, Strohben I, Elias N, Azhar A, Shah M, Eason J, Binari LA, Talwar M, Balaraman V, Bhalla A, Besharatian B, Molnar MZ. Association of Donor Hepatitis C Virus Infection Status and Risk of Bk Polyomavirus Viremia After Kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/association-of-donor-hepatitis-c-virus-infection-status-and-risk-of-bk-polyomavirus-viremia-after-kidney-transplantation/. Accessed December 7, 2021.
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