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Slipping Through the Cracks: Late Onset BK Viremia.

J. Gandhi,1 M. Mackenzie,1 D. DeWolfe,2 F. Cardarelli,3 M. Pavlakis,3 C. Tan.1,4

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

Related Abstracts
  • Simultaneous Pancreas/Kidney Transplantation Increases the Risk of Late-Onset BKV-Associated Nephropathy.
  • Impact of Sirolimus on the Risk of BK Viremia in Simultaneous Pancreas-Kidney Transplant Recipients

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).

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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.

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