BK Viremia: A Double Edged Sword – The Impact of Immunosuppression Reduction on Allograft Rejection
1Pharmacy, University Cleveland Medical Center, Cleveland, OH, 2Nephrology, University Cleveland Medical Center, Cleveland, OH, 3Surgery, University Cleveland Medical Center, Cleveland, OH
Meeting: 2020 American Transplant Congress
Abstract number: B-202
Keywords: Graft function, Infection, Kidney transplantation, Polyma virus
Session Information
Session Name: Poster Session B: Kidney: Polyoma
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: BK viremia (BKV) increases the risk of renal allograft loss following transplant. Guidelines recommend reduction of immunosuppression (IS) after BKV diagnosis, however, the ideal sequence for IS reduction remains unknown. At our institution, we sought to review management of BKV to identify a standardized approach to IS reduction.
*Methods: Retrospectively reviewed adult kidney transplant (KT) recipients that developed BKV (defined by ≥10,000 copies/mL) between 11/1/17 and 10/31/19.
*Results: Fifteen of 153 patients (9.8%) developed BKV after KT. Eight had initial BK PCRs > 10,000 and 7 developed BK PCRs > 10,000. Patients developed BKV on average 3.5 months post-KT. Demographics are in Table 1. Two patients developed BK nephropathy. Interventions leading to BKV clearance are in Table 2. There was no standardized approach to IS reduction with regards to first IS agent reduced, initial BK PCR, or time between IS changes. Patients requiring 2 or more IS changes had BK PCRs ≥ 20,000. Four patients received IVIG for BKV: 1 cleared viremia prior to receiving IVIG, 1 already exhibited a downward trend of viremia, 1 cleared viremia with IVIG alone, and 1 had clearance of BKV after receiving IVIG as salvage therapy. IS reduction led to rejection in 7 out of 15 patients (47%). Of these 7 patients, 4 had PCRs > 100,000. Three patients had cellular rejection, 3 had cellular rejection and BK nephropathy, and 1 had mixed cellular and antibody rejection. Two patients developed de novo DSA after IS reduction. There was no graft failure or patient death.
*Conclusions: Reduction of IS resulted in resolution of BKV. A clinically significant number of patients developed rejection after IS reduction, but there was no graft failure or patient death. IVIG was used in 2 patients and found to be effective. The contribution of alloantibody to post BKV outcomes needs to be investigated. These results demonstrate the need for a standardized approach to IS reduction in patients with BKV to prevent development of rejection. Based on this, a revision of our protocol for BKV management will be made.
| Characteristics | N = 15 |
| Age, mean ± SD | 52.1 ± 12.2 |
| Gender, n (%) Male | 10 (66.7) |
| KDPI, % mean ± SD | 57 ± 25 |
| Cold Ischemia Time, mins mean ± SD | 832 ± 403.7 |
| Induction, n (%) Antithymocyte globulin Basiliximab | 8 (53.3) 7 (46.7) |
| Time to BK development from transplant (months) mean ± SD | 3.5 ± 2.6 |
| Peak BK PCR (copies/mL) mean ± SD | 115936 ± 126782 |
| Intervention | n (%) (N=15) |
| Reduction in MMF dose | 4 (26.6) |
| Reduction of TAC goal | 1 (6.7) |
| 2 or more changes to IS | 6 (40) |
| IS change + IVIG | 3 (20) |
| IVIG alone | 1 (6.7) |
To cite this abstract in AMA style:
Szczepanik A, Bixby A, Burrelli C, Padiyar A, Srinivas T, Chavin K. BK Viremia: A Double Edged Sword – The Impact of Immunosuppression Reduction on Allograft Rejection [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/bk-viremia-a-double-edged-sword-the-impact-of-immunosuppression-reduction-on-allograft-rejection/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress