The purpose of this study is to determine the incidence of rejection and donor specific antibody (DSA) formation after immunosuppression reduction in patients with biopsy proven polyomavirus nephropathy (PVN). We identified 57 out of the 617 patients (9.2%) who received a kidney transplant at our center between 1/1/2009 and 4/28/2017 who were given a histologic diagnosis of polyomavirus nephropathy between 4/29/2009 and 4/28/2017. Electronic medical records were reviewed to find occurrence of rejection episodes and donor antibody formation prior to and following the diagnosis of PVN, and methods of immunosuppression reduction or other therapies. Graft function and survival were ascertained by comparing the estimated glomerular filtration rate (eGFR) with the Modification of Diet in Renal Disease Study equation at the time of diagnosis to the eGFR at a mean follow up of 20.2 months. Nephrologists approached treatment differently, however anti-metabolites were stopped or dose-reduced and tacrolimus trough level goals were decreased to 4-7 ng/mL in all those reviewed. Forty-eight of the 57 patients were treated with leflunomide and three received intravenous immune globulin for PVN. Six of the 57 patients (10.5%) had an episode of rejection preceding PVN diagnosis (5 had acute cellular rejection [ACR], 1 had acute antibody mediated rejection [AMR]) and 13 patients (22.8%) had an episode of rejection after the diagnosis of PVN (11 had ACR, 1 had AMR, 1 had mixed ACR and AMR). In those who developed rejection after PVN, it occurred an average of 10.1 months after the diagnosis. Eleven patients (19.3%) developed a DSA (5 had Class 1 antigens and 6 had Class 2 antigens) and a DSA was found after PVN diagnosis in 7 (11.4%) patients. Among the patients who developed DSAs, two had a history of ACR prior to DSA discovery. Average eGFR at the time of PVN diagnosis was 43.7 mL/min and 40.6 mL/min at follow up. Five patients developed end stage renal disease requiring dialysis: 1 patient due to recurrent glomerulonephritis, 1 patient due to rejection, and 2 patients due to PVN. Four patients died (2 had death with functioning graft). Our findings suggest that reduction in immunosuppression after diagnosis of PVN is associated with a possible increase in the incidence of rejection and DSA development. Fortunately, this does not seem to have an immediate impact on graft survival, but there does appear to be an association with reduced graft function.

CITATION INFORMATION: Kleman M., Detwiler R., Singh H., Nickeleit V. Incidence of Rejection and Antibody Formation after Immunosuppression Reduction in Patients with Biopsy Proven Polyomavirus Nephropathy Am J Transplant. 2017;17 (suppl 3).

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