Background: BK virus (BKV) is a common infection in kidney transplant recipients. Due to widespread latent BKV infection in the general population, it is possible that either the recipient or donor may act as the source of reactivation. Few studies have analyzed the effect of donor and recipient serostatus on the risk of BKV reactivation. In addition, the fluoroquinolone ciprofloxacin has previously been investigated as a prophylactic agent against BKV, but its effect has not been analyzed in relation to BKV serostatus.

Methods: Using neutralization assays with representative variants from all four BKV serotypes, we retrospectively determined the pre-transplant serostatus of 116 donor (D)-recipient (R) pairs to determine the impact of serostatus on development of BK viremia after kidney transplantation. A subset of patients (n=61) received ciprofloxacin 250mg twice daily for 30 days as part of a BKV prophylaxis protocol. Thus, we also investigated the effect of ciprofloxacin on incidence of viremia stratified by BKV serostatus.

Results: There was no difference in baseline demographics or transplant data between serostatus groupings, with the exception of PRA which was highest in the D-/R+ group. The table demonstrates the incidence and risk of BK viremia at 12 months post-transplant based on donor and recipient BKV serostatus.

Recipients of kidneys from D+ donors showed the greatest risk for viremia, regardless of recipient serostatus (D+ versus D-: OR 5.9 [CI 2.5-16.7]; P=0.0003). Prophylaxis with ciprofloxacin had no effect on risk of viremia, including when donor serostatus was taken into account (OR 1.4: 0.4-5; P=0.6).

Conclusions: Donor serostatus correlated significantly with incidence of post-transplant BKV viremia, while prophylaxis with ciprofloxacin had no risk reduction effect. Determination of donor serostatus may be useful in assessing risk of BKV reactivation in kidney transplant recipients.

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