Slipping Through the Cracks: Late Onset BK Viremia.
1Center for Virology & Vaccine Research, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA
2Division of Nephrology, BIDMC, Boston, MA
3The Transplant Institute, BIDMC, Boston, MA
4Division of Infectious Disease, BIDMC, Boston, MA.
Meeting: 2016 American Transplant Congress
Abstract number: D223
Keywords: Kidney transplantation, Nephropathy, Polyma virus, Renal dysfunction
Session Information
Date: Tuesday, June 14, 2016
Session Name: Poster Session D: Polyomavirus
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction: Most studies indicate that viremia caused by BK virus (BKV), the step preceding BKV associated nephropathy (BKVN) in kidney transplant recipients (KTRs), occurs within one year of transplantation. In a retrospective analysis, we have found a significant percentage of patients develop viremia after one year. Due to a lack of universal screening protocol and systemic screening, KTRs remain profoundly at risk for being undiagnosed with BKV and subsequent allograft injury.
Methods: At a single center study, we screened for BK viremia in KTRs transplanted between 2003-2011 and found 50 patients with viremia. We divided patients into two groups: patients who had BK viremia diagnosed less than one year after transplant and patients who tested positive after one year. They were deemed “early” and “late” BK virus patients accordingly. We then compared the “early BK” and “late BK” cohorts for patient characteristics, ESRD diagnosis, immunosuppression, and graft outcomes.
Table 1: Patient Characteristics
| Early n=35 | Late n=15 | P-Value | |
|
Days to BK Viremia Diagnosis |
142.9 + 14.8 | 977.7 + 141.2 | 0.0001 |
| Recipient Age (yrs) | 56.2 + 1.7 | 50.0 + 3.2 | 0.05 |
| Donor Age (yrs) | 47.9 + 3.0 | 43.0 + 3.6 | 0.15 |
| Donor-Recip. Gender Mismatch n | 20 | 4 | 0.07 |
| HLA Mismatches | 4.0 + 0.3 | 4.5 + 0.4 | 0.37 |
| CMV Status (Donor-Recip. Mismatch) | 7 | 7 | 0.09 |
| Diabetes n | 11 | 1 | 0.08 |
Table 2: Immunosuppression & Kidney Function
|
Early n=35 |
Late n=15 |
P-value | |
| Mycophenolate Mofetil n | 28 | 14 | 0.41 |
| Prednisone n | 9 | 7 | 0.19 |
| Creatnine at Baseline mg/dL | 1.1 + 0.3 | 1.9 + 0.2 |
0.001 |
| Creatnine at Diagnosis mg/dL | 1.6 + 0.1 | 2.2 + 0.3 | 0.7 |
|
Rise in Creatinine from Baseline to Diagnosis mg/dL |
0.80 + 0.2 | 0.3 + 0.1 | 0.007 |
| BKV Nephropathy n | 9 | 3 | 1.0 |
* Baseline: 5 visit average prior to BK diagnosis
Conclusions: A significant portion of our patients presented with BK viremia when we no longer systemically screened for BKV. Other than recipient age and creatinine at baseline, we found few diagnostic clues to differentiate between the onset of BK viremia between the “early” and “late” BKV patient cohorts. A more formalized and prolonged screening strategy, beyond one year, is indicated to prevent kidney dysfunction caused by BK virus in KTRs.
CITATION INFORMATION: Gandhi J, Mackenzie M, DeWolfe D, Cardarelli F, Pavlakis M, Tan C. Slipping Through the Cracks: Late Onset BK Viremia. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Gandhi J, Mackenzie M, DeWolfe D, Cardarelli F, Pavlakis M, Tan C. Slipping Through the Cracks: Late Onset BK Viremia. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/slipping-through-the-cracks-late-onset-bk-viremia/. Accessed March 8, 2021.« Back to 2016 American Transplant Congress