High Incidence of BKPyV DNAemia After Simultaneous Pancreas-Kidney Transplantation

I. Helanterä¹, J. Räihä¹, S. von Moos², I. Lautenschlager³, V. Sallinen¹, M. Lempinen¹, T. Schachtner²

¹Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland, ²University Hospital Zurich, Zurich, Switzerland, ³Department of Virology and Immunology, Helsinki University Hospital, Helsinki, Finland

Meeting: 2022 American Transplant Congress

Abstract number: 253

Keywords: Kidney/pancreas transplantation, Polyma virus

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: 3:40pm-3:50pm

Location: Hynes Room 309

*Purpose: Polyomavirus BK (BKPyV) commonly reactivates after kidney transplantation and causes significant morbidity and increased risk of graft loss. However, data on the burden of BKPyV infections after simultaneous pancreas-kidney (SPK) transplantation are limited.

*Methods: All SPK transplantations from Helsinki University Hospital between 2010-2019 (N=168) and from University Hospital Zurich between 2009-2018 (N=67) were included. Control group included matched patients with type 1 diabetes as the cause of end-stage kidney disease, who received a deceased donor kidney-only transplantation (N=159) or who received the paired kidney from the deceased SPK donor (N=108). BKPyV DNAemia was routinely monitored with quantitative PCR. The frequency, severity, and outcome of BKPyV infections were recorded.

*Results: Induction immunosuppression was used in all SPK patients (16 basiliximab vs. 219 ATG) and all received tacrolimus-based triple immunosuppression, whereas only 38/267 (14%) of the kidney-only recipients received induction (32 basiliximab, 6 ATG) and 179/267 (67%) were on cyclosporine-based immunosuppression. BKPyV DNAemia was detected in 49/235 (21%) of the SPK recipients, compared to 6/267 (2.2%) in the kidney-only recipients (P<0.001). BKVPyV DNAemia was >10,000 copies/ml plasma (presumptive polyomavirus-associated nephropathy) in 20/235 (9%) of the SPK recipients, compared to 2/267 (0.7%) of the kidney-only recipients (P<0.001). No significant differences were seen in the duration of BKPyV DNAemia or the peak viral loads between the groups. BKPyV infections were successfully treated with reduction of immunosuppression (mycophenolate dose reduction or cessation) in all except five SPK recipients who additionally required treatment with IvIG (N=4) or leflunomide (N=1). Two SPK patients still have ongoing viremia for over 3 years despite interventions. One patient developed acute pancreas graft rejection after reduction of immunosuppression, but no kidney or pancreas grafts were lost due to BKPyV or reduction of immunosuppression. Five SPK recipients developed de novo donor-specific antibody after reduction of immunosuppression due to BKPyV.

*Conclusions: The burden of BKPyV seems increased in SPK recipients, who receive more intensive immunosuppression. Reduction of immunosuppression was mostly safe and effective also in SPK recipients.

To cite this abstract in AMA style:

Helanterä I, Räihä J, Moos Svon, Lautenschlager I, Sallinen V, Lempinen M, Schachtner T. High Incidence of BKPyV DNAemia After Simultaneous Pancreas-Kidney Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/high-incidence-of-bkpyv-dnaemia-after-simultaneous-pancreas-kidney-transplantation/. Accessed December 3, 2024.

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