Polyoma Viremia Adversely Affects Renal Function at One Year in Kidney Transplant Recipients: Independent of Immunosuppressive Regimen
Div. Transplantation/Surgery, University of California, Irvine School of Medicine, Orange, Ca.
Meeting: 2013 American Transplant Congress
Abstract number: C1371
Background:
Polyoma virus (BKV) reactivation is a complication in renal transplant recipients that can lead to BKV nephropathy (BKVN) and allograft loss.
The purpose of this study is to evaluate induction therapy choice with Rabbit anti-thymocyte globulin (RATG) vs. Basiliximab (anti-IL2). A secondary endpoint is to determine whether maintenance IS regimen with or without long-term steroid therapy is an independent risk factor for BKV replication and if steroid avoidance may reduce the emergence of BKV in kidney transplant recipients.
Method:
A retrospective, single-center analysis of 243 kidney transplant recipients from July 1, 2005 – September 15, 2012 was performed. Induction IS was RATG or anti-IL2 along with maintenance IS consisted of TAC/MMF, CSA/MMF, TAC/ERL, SRL/MMF +/- prednisone. The incidence of BKV viremia, BKVN, serum creatinine at 6 months and 1 year, and allograft loss were analyzed.
Results:
90.5% (220) were BKV(-), 9.5% (23) BKV(+). Patient demographics and transplant characteristics were comparable except the BKV(+) patients had a lower BMI (p-0.027). The CSA/MMF group had a larger percent develop BKV(+), 13% vs 2.7% (p- 0.017). Induction IS regimen selection and maintenance steroid did not increase the incidence of BKV viremia. 13%(3) patients in the BKV(+) group developed BKVN and 52% were converted to Leflunomide. Creatinine Clearance (1-year) was statistically lower in the BKV(+) group vs. the BKV(-) Group, 54.8 ml/min vs. 69.7ml/min (P-0.037).
| Characteristic | BKV(+), n=23 | BK (-) , n=220 |
| Age (years) | 46.1 | 45.6 |
| BMI (kg/m2) | 24.43 | 26.53 * |
| DGF | 26% (6) | 30% (67) |
| Male | 78.3 %(18) | 65%(143) |
| Female | 21.74% (5) | 35% (77) |
| African-American | 8.7 % (2) | 3.18% (7) |
| Asian-American | 13 %(3) | 19.5%(43) |
| Hispanic | 21.7%(5) | 17.7 %(39) |
| Caucasian | 56.5%(13) | 59.5% (131) |
| LDKT | 39.1% (9) | 33.2%(73) |
| DDKT | 60.9% (14) | 66.8%(147) |
| BKV(+) | BKV(-) | |
| Type of Induction | ||
|---|---|---|
| RATG | 39.1%(9) | 39.1% (86) |
| Anti-IL2 | 60.9%(14) | 60.9% (134) |
| Maintenance IS | ||
| Steroids-Yes | 87%(20) | 90%(198) |
| Steroids-No | 13%(3) | 10%(22) |
| TAC/MMF | 82.6%(19) | 92.3%(203) |
| CSA/MMF | 13%(3) | 2.73%(6)* |
| TAC/ERL | 4.3%(1) | 1.8% (4) |
| SRL/MMF | 0 | 2.7% (6) |
Conclusion:
The choice of induction therapy did not increase the incidence of BKV viremia. The presence of BKV viremia adversely affected kidney transplant allograft function at one year.
To cite this abstract in AMA style:
Nguyen K, Weng R, Foe-Parker J, Ichii H, III CFoster. Polyoma Viremia Adversely Affects Renal Function at One Year in Kidney Transplant Recipients: Independent of Immunosuppressive Regimen [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/polyoma-viremia-adversely-affects-renal-function-at-one-year-in-kidney-transplant-recipients-independent-of-immunosuppressive-regimen/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress