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Incidence and Outcomes of Polyomavirus Infection in 639 Kidney Transplant Recipients: Are High Immunological Risk Characteristics More Relevant Than Specific Induction Or Maintenance Immunosuppressive Regimens?

E. Favi,1 L. Harris,2 J. Worsfold,2 R. Cacciola,1 C. Puliatti,1 C. Sammartino,1 R. Sivaprakasam.1

1Transplantation, Royal London Hospital, London, United Kingdom
2Barts and The London School of Medicine and Dentistry, London, United Kingdom.

Meeting: 2015 American Transplant Congress

Abstract number: A24

Keywords: Immunosuppression, Kidney transplantation, Polyma virus, Risk factors

Session Information

Date: Saturday, May 2, 2015

Session Name: Poster Session A: BK Virus Infection

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Exhibit Hall E

Related Abstracts
  • Perturbation of Polyomavirus Nephropathy-Specific Gene Expression in Kidney Allografts
  • Longterm Outcome in Pancreas Grafts After Polyomavirus Infection in Combined Kidney-Pancreas Transplants: A Single Center Report

Introduction.

Polyomavirus-associated nephropathy (PVAN) is now recognized as an important cause of graft dysfunction and early kidney transplant loss. Over-immunosuppression is the main risk factor for the development of PVAN. Donor and recipient characteristics do play a role but conclusive evidences are still lacking.

Methods.

In this single centre cohort study performed analysing data retrieved from a prospectively collected database we evaluated incidence, outcomes and risk factors of Polyomavirus infection in 639 consecutive kidney transplants performed between 2007 and 2013.

Results.

During a mean follow up of 4.5 years, viremia was detected in 54/639 patients (8%); 26/639 recipients (4%) had biopsy-proven PVAN. Death-censored graft loss rate was significantly higher in patient with PVAN compared to recipients with no viremia: 42% (10/24) vs. 14% (76/523), respectively (p<0.05). After immunosuppression reduction, 43/54 patients (80%) effectively managed to clear the virus with preserved renal function; 4 patients (7%) experienced biopsy-proven acute rejection. Two cases (4%) of ureteral stenosis were observed. The risk factors for Polyomavirus active infection were: higher recipient BMI, Afro-Caribbean recipient, older donor age, higher HLA DR and overall mismatch, lack of CMV prophylaxis, and biopsy-proven rejection (p<0.05). Induction (ATG vs. anti-IL-2 receptor antagonists) and baseline immunosuppression (Tacrolimus vs. Cyclosporine) did not affect Polyomavirus viremia or PVAN rates.

Conclusions.

Our results show that PVAN significantly reduces kidney allograft survival and identifies a need for post-transplant aggressive screening, prompt reduction of the net state of immunosuppression and possibly use of more reliable tools to assess virus-specific immune response. It also supports our hypothesis that high immunological risk characteristics are more relevant than immunosuppressive regimens.

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To cite this abstract in AMA style:

Favi E, Harris L, Worsfold J, Cacciola R, Puliatti C, Sammartino C, Sivaprakasam R. Incidence and Outcomes of Polyomavirus Infection in 639 Kidney Transplant Recipients: Are High Immunological Risk Characteristics More Relevant Than Specific Induction Or Maintenance Immunosuppressive Regimens? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/incidence-and-outcomes-of-polyomavirus-infection-in-639-kidney-transplant-recipients-are-high-immunological-risk-characteristics-more-relevant-than-specific-induction-or-maintenance-immunosuppressive/. Accessed April 18, 2021.

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