Impact of Target Tacrolimus Levels on BK Polyomavirus DNAemia and Allograft Rejection Among Pediatric Kidney Transplant Recipients
1Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, 2Children's Healthcare of Atlanta, Atlanta, GA, 3Yale University School of Medicine, New Haven, CT
Meeting: 2022 American Transplant Congress
Abstract number: 809
Keywords: Immunosuppression, Infection, Kidney transplantation, Rejection
Topic: Clinical Science » Kidney » 43 - Kidney: Pediatrics
Session Information
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: BK Polyomavirus (BK) DNAemia is a serious and common infectious complication after kidney transplant (KT). We evaluated the impact of targeting lower tacrolimus levels on the incidence of early-onset BK DNAemia in pediatric KT recipients at our center.
*Methods: We conducted a retrospective chart review of 151 episodes of KT between 01/2013-12/2018 expanding upon a quality improvement project implemented in March 2015 to decrease target tacrolimus levels by 25% prompted by a cluster of early-onset BK DNAemia cases. Of the 129 patients included in analysis, 46 were in the pre-intervention cohort, and 83 were in the post-intervention cohort. All patients received same induction regimen.
*Results: Median age at KT [13(IQR 7 – 16) years], sex (65% male), and race (58% White, 34% Black) were not significantly different between cohorts. Overall, 53% of patients received deceased donor KT, 21% had underlying urologic disorder, and 13% had prior urologic procedures. A total of 32.6 % (42/129) of patients developed BK DNAemia within 18 months post-KT. The post-intervention cohort had non-significant lower incidence of early-onset BK DNAemia within 100 days post-KT (14 vs. 20 per 100 patients), longer median time to first detected BK DNAemia [139 (IQR 56 – 181) vs. 78 (IQR 59 – 184) days], shorter duration of BK DNAemia [59 (IQR 29 – 83) vs. 123 (IQR 57 – 301) days], and lower median peak viral load [16015 (IQR 3236 – 39185) vs. 30688 (IQR 1716 – 58541) DNA copies/mL]. More patients in the post-intervention cohort had at least one episode of biopsy-proven rejection within 18 months post-KT (42% vs. 37%, p= 0.56) and earlier development of donor-specific antibody (DSA) (p=0.042).
*Conclusions: The revised immunosuppression protocol resulted in reduction of early-onset BK DNAemia cases and more rapid clearance of BK DNAemia without reaching statistical significance. However, we observed a slight increase of rejection and de novo DSA in the post-intervention cohort which may portend worse long-term graft survival. Modification of early immunosuppression to prevent viral infection in children should be balanced against possible increased risk of rejection.
To cite this abstract in AMA style:
Huang H, Winterberg P, George R, Serluco A, Liverman R, Yildirim I, Garro R. Impact of Target Tacrolimus Levels on BK Polyomavirus DNAemia and Allograft Rejection Among Pediatric Kidney Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-target-tacrolimus-levels-on-bk-polyomavirus-dnaemia-and-allograft-rejection-among-pediatric-kidney-transplant-recipients/. Accessed May 9, 2025.« Back to 2022 American Transplant Congress