Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients with Biopsy Proven BK Polyomavirus Associated Nephropathy

H. Omic¹, J. P. Kläger¹, H. Herkner¹, S. W. Aberle¹, H. Regele¹, L. Weseslindtner¹, T. A. Schrag¹, G. Bond¹, K. Hohenstein¹, B. Watschinger¹, J. Werzowa², R. Strassl¹, M. Eder¹, Z. Kikic¹

¹Medical University of Vienna, Vienna, Austria, ²Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria

Meeting: 2022 American Transplant Congress

Abstract number: 260

Keywords: Kidney transplantation, Polyma virus, Renal failure

Topic: Clinical Science » Infection Disease » 26 - Kidney: Polyoma

Session Information

Session Name: Kidney: Polyoma Infections

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

Session Time: 3:30pm-5:00pm

Presentation Time: 4:50pm-5:00pm

Location: Hynes Room 309

*Purpose: The absolute BK viral load is an important diagnostic surrogate for BK polyomavirus associated nephropathy (PyVAN) after renal transplant (KTX) and serial assessment of BK viremia is recommended. However, there is no data indicating which particular viral load change, i.e., absolute vs. relative viral load changes (copies/ml; percentage of the preceding viremia) is associated with worse renal graft outcomes.

*Methods: In this retrospective study of 91 biopsy proven PyVAN we analyzed the interplay of viremia exposure time, absolute and relative viral load kinetics, baseline risk and treatment strategies as risk factors for graft loss after 2 years using a multivariable Poisson regression model.

*Results: We compared two major treatment strategies: standardised immunosuppression (IS) reduction (n=53) and Leflunomide (n=30). The median viral load at the index biopsy was 2.15E+04 copies/ml (IQR 1.70E+03-1.77E+05) and median peak viremia was 3.6E+04 copies/ml (IQR 2.7E+03-3.3E+05). Treatment strategies and IS-levels were not related to graft loss. After correction for baseline viral load and baseline eGFR, absolute viral load decrease/unit remained an independent risk factor for graft loss [IRR=0.77, (95% CI 0.61-0.96), p=0.02].

*Conclusions: This study provides evidence for the prognostic importance of absolute BK viremia kinetics as a dynamic parameter indicating short-term graft survival independently of other established risk factors. Our findings support serial measurement of absolute BK viremia load changes to early identify patients with persistent viremia levels and consequently higher risk for graft loss.

To cite this abstract in AMA style:

Omic H, Kläger JP, Herkner H, Aberle SW, Regele H, Weseslindtner L, Schrag TA, Bond G, Hohenstein K, Watschinger B, Werzowa J, Strassl R, Eder M, Kikic Z. Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients with Biopsy Proven BK Polyomavirus Associated Nephropathy [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-relevance-of-absolute-bk-polyoma-viral-load-kinetics-in-patients-with-biopsy-proven-bk-polyomavirus-associated-nephropathy/. Accessed May 9, 2025.

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