Incidence, Risk Factors and Outcomes of BK Viremia and Nephropathy Following Kidney, Simultaneous Kidney-Pancreas or Pancreas after Kidney Transplant

J. Descourouez, D. Hager, G. Leverson, R. Hofmann, A. Djamali, J. Bellingham, J. Odorico, H. Sollinger, J. Pirsch

University of Wisconsin Hospital, Madison, WI

Meeting: 2013 American Transplant Congress

Abstract number: 506

We examined the incidence and risk factors for BK viremia and nephropathy (BKV and BKN) and their impact on graft survival in kidney, simultaneous kidney-pancreas (SPK) and pancreas after kidney (PAK) patients.

This is a single center study of 2211 adult patients [1138 deceased-donor renal transplants (DDRT), 726 living-donor renal transplants (LDRT), 297 SPK, and 50 PAK] between 2003-2010. Definition of BKV was >1×10^4 copies/mL by plasma PCR and BKN by immunoperoxidase biopsy staining.

Mean follow up was 4.37 ± 1.99 years. Incidence of BKV at 4 years was: 10.1% in DDRT, 6.20% in LDRT, 9.40% in SPK and 8.22% in PAK recipients. Incidence of BKN was: 3.68% in DDRT, 2.73% in LDRT, 3.56% in SPK and 6.09% in PAK patients. DDRT patients who developed BKV or BKN had reductions in graft survival (p<0.01 and p=0.01). LDRT patients who developed BKV or BKN trended toward reduced graft survival (p=0.056 and p=0.057). In SPK patients, BKV did not impact survival of either graft (p=0.40, p=0.46), nor did BKN (p=0.77, p=0.75). Univariate and multivariate analysis found risk factors in DDRT, LDRT, and SPK recipients.

Table 1. Risk Factors for BKN
	Univariate		Multivariate
	p-value	HR	p-value	HR
DDRT
DGF	0.01	2.23	0.02	2.13
Male Recipient	0.03	2.15	0.06	2.00
LDRT
Cyclosporine Maintenance	0.03	0.20	0.08	0.25
Non-CNI Maintenance	0.03	5.01	0.21	0.44
Rejection at 30-days	0.01	3.88	0.02	3.28

Table 2. Risk Factors For BKV
	Univariate		Multivariate
	p-value	HR	p-value	HR
DDRT
Donor Age	0.04	1.01	0.04	1.01
Tacrolimus Maintenance	0.01	2.23	0.04	2.05
Caucasian Recipient	<0.01	0.51	<0.01	0.50
Male Recipient	0.02	1.63	0.04	1.53
Avg Prednisone Dose	<0.01	1.02	<0.01	1.02
Avg Tacrolimus Dose	0.02	1.07	0.83	1.01
SPK
Campath vs Thymo Induction	<0.01	0.19	<0.01	0.16
IL-2 vs Thymo Induction	0.05	0.28	0.04	0.26
Recipient Age	0.04	1.06	0.02	1.05
LDRT
Avg Tacrolimus Dose	<0.01	1.09	0.15	1.05
Tacrolimus Maintenance	0.04	2.08	0.28	1.56
Rejection at 30-days	0.02	2.44	0.08	2.10
Male Recipient	0.02	2.22	0.02	2.25

In SPK patients, induction with alemtuzumab or interleukin-2 receptor antagonists was protective against BKV compared to thymoglobulin (p<0.01 and p=0.04).

We report the 4 year incidence of BKV and BKN following kidney and/or pancreas transplant. The rate of BKN was highest in PAK pateints. B

To cite this abstract in AMA style:

Descourouez J, Hager D, Leverson G, Hofmann R, Djamali A, Bellingham J, Odorico J, Sollinger H, Pirsch J. Incidence, Risk Factors and Outcomes of BK Viremia and Nephropathy Following Kidney, Simultaneous Kidney-Pancreas or Pancreas after Kidney Transplant [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/incidence-risk-factors-and-outcomes-of-bk-viremia-and-nephropathy-following-kidney-simultaneous-kidney-pancreas-or-pancreas-after-kidney-transplant/. Accessed November 22, 2024.

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