Background: BK virus is a recognized cause of kidney allograft dysfunction. The treatment of BK is immunosuppression reduction. This reduction in patients with a simultaneous pancreas and kidney transplant (SPK) may increase immunologic risk leading to rejection of one or both organs and organ loss. We sought to examine the effect of post transplant development of BK viremia on the risk of rejection and death censored graft loss (DCGL) for either organ in SPK patients at our institution.

Methods: Between 2006 and 06/2017, 181 unique patients underwent SPK transplantation. We looked at DCGL and cellular and antibody mediated rejection by biopsy for cause in these patients. Multivariate Cox models were performed using development of post-transplant BK viremia as a time-dependent covariate; we also adjusted for age, race, and time from DM diagnosis to transplant.

Results: Graft function and rejection KM curves are shown in Figures 1 and 2. BK viremia developed in 30/181 patients (16.6%). Development of BK viremia significantly increased the risk of acute cellular rejection (Table 1)(HR 3.75 CI (1.42, 9.95) p=0.0078). There was no significant effect of BK viremia on antibody mediated rejection (HR 1.43 CI (0.17, 11.88) p=0.7385) or DCGL (HR 1.054 CI (0.31, 3.57) p=0.9329).

Conclusion: BK viremia/treatment was associated with an increased risk of cellular rejection, but not antibody mediated rejection. Despite this increase in rejection, BK viremia did not affect the risk of death censored graft loss.

CITATION INFORMATION: Keys D., Riad S., Vakil V., Jackson S., Berglund D., Matas A., Kandaswamy R. Rejection and Graft Loss in Patients with BK Viremia after Simultaneous Pancreas and Kidney Transplant Am J Transplant. 2017;17 (suppl 3).

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