Prospective Surveillance of Kidney Transplant Recipients for BK Viremia Can Reduce or Eliminate BK Virus Associated Nephropathy (BKVAN) Related Graft Loss: Results of a 5-Year Screening Study
Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
Infectious Disease/Medicine Institute, Cleveland Clinic, Cleveland, OH
Meeting: 2013 American Transplant Congress
Abstract number: C1359
Purpose: We aimed to identify the incidence and risk factors for BKVAN as well as measure the impact of immediate therapy on the graft and patient survival in the era of BKV screening.
Methods: We included 609 recipients who had undergone kidney or kidney/pancreas transplant from January 2007 to June 2011. Patients were screened at transplant, monthly for 6 months and bimonthly from 6 to 12 for BK viremia using qPCR. There were 7453 tests done (11.9/patient). Recipients had biopsies at implant; protocol at 3, 12, and 24 mos., or for cause for increased serum creatinine. Patients who demonstrated positive renal in situ hybridization for BKV were designated BKVAN. There were 29 clinical and demographic risk factors analyzed.
Results: We found the incidence of BK viremia at any time was 163/609=26.7%, 1-year 130/609-21.3%; and BKVAN 8/609= 1.3%. Significant risk factors for BKVAN were BKV copies at the onset of viremia and the peak BK copies (p=0.009 and 0.001 respectively). ROC analysis using logistic regression was performed to predict the occurrence of BKVAN using the first positive BKV and the peak BKV viral loads. We found that >185,000 copies/mL – at the time of the first positive BKV diagnosis – to be the strongest predictor for BKVAN with 97% specificity and 75% sensitivity (AUC: 91%) (OR 113.25, 95% CI 17.22-744.6, P=<0.001). In addition, the BKV peak viral loads reaching 223,000 copies/mL at any time was found to be predictive for BKVAN with 91% specificity and 88% sensitivity (AUC: 95%) (OR 70.5, 95% CI 8.08-615, P= 0.0001). No kidneys demonstrated BKVAN without viremia. The 8 BKVAN patients were treated with reduction in IS drugs [n=1], reduction in IS drugs + leflunomide [n=5], and reduction in IS drugs + leflunomide + ciprofloxacin [n=2]. Of these 8 patients, 0 had graft failure, 1 died with graft function at 11 months from mucormycosis, and 7 remain with graft function.
Conclusions: By incorporating BK viremia surveillance into routine practice BKVAN can be predicted; and permits early diagnosis and intervention, which may result in maximal graft preservation.
To cite this abstract in AMA style:
Elfadawy N, Flechner S, Liu X, Schold J, Fatica R, Srinivas T, Poggio E, Avery R, Mossad S. Prospective Surveillance of Kidney Transplant Recipients for BK Viremia Can Reduce or Eliminate BK Virus Associated Nephropathy (BKVAN) Related Graft Loss: Results of a 5-Year Screening Study [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/prospective-surveillance-of-kidney-transplant-recipients-for-bk-viremia-can-reduce-or-eliminate-bk-virus-associated-nephropathy-bkvan-related-graft-loss-results-of-a-5-year-screening-study/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress