Introduction:

It has been long established that over-immunosuppressed state leads to BK virus reactivation. BK viraemia (BKV) can progress to BK virus associated nephropathy (BKVAN) which can cause graft loss. Augmented immunosuppression involves agents such as Anti-thymocyte globulin (ATG) and Campath for treating acute rejection. They may cause state of over-immunosuppression and possible viral reactivation.

Aims: In patients who received standard versus augmented immunosuppression, a) to compare incidence of BKV and BKVAN and b)1 year and 5 year graft survival.

Method:

This is a retrospective study on kidney transplant recipients from 1st Jan 2006 until Dec 31st 2016. Standard immunosupresion included Basiliximab (induction) and triple maintenance therapy. Augmented immunosuppression involved use of ATG/Campath to treat acute rejection episodes in addition to standard immunosuppression.

BK viraemia was diagnosed on BK PCR results and BKVAN was diagnosed on renal biopsy.

Data was collected from electronic data base and Fisher's exact T test was applied for statistical analysis.

Discussion:

Augmented IS group had statistically significant increased incidence of BKV (p=0.007) as compared to standard IS group.

However, there was no statistically significant difference in the incidence of BKVAN in the two groups (p=0.344)

Mean eGFR at 1 year was 40 ml/min and mean creatinine was 144 for standard IS group and mean eGFR at 5 years was 38 ml/min and mean creatinine was 210 for standard IS group that developed BKV.

Mean eGFR at 1 year was 34 ml/min and mean creatinine was 191 for augmented IS group and mean eGFR at 5 years was 30 ml/min and mean creatinine was 285 for augmented IS group that developed BKV.

Only 7 (14.5%) patients developed BKV associated nephropathy but there were no instances of graft loss.

Conclusions:

Patients receiving augmented immunosuppression in the form of ATG and Campath need to be monitored more frequently for BK levels and as there is a statistically higher incidence of BK viraemia in this population.

If BK viraemia is detected early and managed with reduction of immunosuppression, BK nephropathy and consequent graft loss can be avoided.

CITATION INFORMATION: Rathore R., Anastassiadou S., Kaur A., Timms J., Krishnan N. Incidence of BK Viraemia and BK Virus Associated Nephropathy with Standard vs. Augmented Immunosuppression Am J Transplant. 2017;17 (suppl 3).

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