Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Room 210
Introduction: Reduced immunosuppression is associated with de novo DSA (dn DSA). Although immunosuppression is often reduced in patients with polyomavirus (BK), the incidence of dn DSA following BK viremia or nephropathy remains unclear. We aimed to study the risk of dn DSA development following BK.
Methods: We performed a retrospective cohort study of solitary kidney transplant recipients from 10/2007 – 5/2014. We examined the incidence of BK viremia (BK blood pcr >15,000 copies) and BK nephropathy (BK viremia + viral cytopathic changes/inclusions on light microscopy + interstitial inflammation) and compared the rate of dn DSA production in these groups to patients without BK. De novo DSA was defined as new DSA MFI>1000. Protocol immunosuppression change for both BK nephropathy and/or viremia >15,000 copies included: CellCept discontinuation, reduced tacrolimus trough to 4-6, and prednisone 10mg/day.
Results: Of 962 kidney transplant recipients, 5.6% (54) had BK viremia (>15,000 copies), 4.6% (44) had BK nephropathy, and 2.3% (23) had both during during mean follow-up of 4.1+/-1.8 years post-transplant. BK nephropathy, but not BK viremia was associated with dnDSA. De novo DSA developed in 5.6% (3/54) of patients after BK viremia and in 6.6% (60/908) in non-BK viremia patients (p=0.76). The rate in BK nephropathy was 13.6% (6/44) versus 5.8% (56/918) in non-BK nephropathy patients (p=0.02) at mean time of 5.8 months (range 0-13.6 months) post-BK. The development of de novo DSA in patients with BK nephropathy was also associated numerically increased allograft failure [50%(3/6) with dn DSA vs. 13.2%(5/38) in patients without dn DSA, but this did not reach statistical significance(p=0.06)].
Conclusion: BK nephropathy, but not isolated BK viremia was associated with de novo DSA, although the incidence in this cohort appears low overall. These findings suggest that allograft inflammation rather than immunosuppression adjustment may contribute to de novo DSA in patients with BK. Further study is needed to identify patients with BK nephropathy at risk for de novo DSA formation to hopefully prevent its development.
Non-BK viremia (>15,000copies)
|p-value||BK nephropathy||No BK nephropathy||p-value|
|De novo DSA||5.6% (3/54)||6.6% (60/908)||0.57||13.6% (6/44)||5.8% (56/918)||0.02|
CITATION INFORMATION: Cheungpasitporn W, Mitema D, Amer H, Cosio F, Stegall M, Schinstock C. BK Nephropathy, but Not Isolated BK Viremia Associated with De Novo DSA Despite Similar Immunosuppression Reduction. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Cheungpasitporn W, Mitema D, Amer H, Cosio F, Stegall M, Schinstock C. BK Nephropathy, but Not Isolated BK Viremia Associated with De Novo DSA Despite Similar Immunosuppression Reduction. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/bk-nephropathy-but-not-isolated-bk-viremia-associated-with-de-novo-dsa-despite-similar-immunosuppression-reduction/. Accessed October 13, 2019.
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