Background: Our study attempts to evaluate the utility of the screening protocol to as a marker of overt immunosuppression as well as any correlation to CMV infection.
Methods: 159 de novo kidney-only recipients were enrolled from January 2011 onwards. Standard immunosuppression with Alemtuzemab or Basiliximab and mycophenolate mofetil (MMF)/FK506 ± prednisone was prescribed. Quantitative BK virus polymerase chain reaction (PCR) surveillance in plasma was performed monthly for the first 6 months then every 3 months for 2 years. Patients with significant viremia (defined as >10,000 gEq/ mL) were treated by stopping MMF and 30% – 60% reduction in doses of FK506 without antiviral therapy. The target 12-hr FK 506 trough levels were lowered to 4 – 5 ng/mL in the significant viremia group, whereas the target levels remained unchanged at 5 – 8 ng/mL for all other groups. The renal biopsy was performed only if renal functions deteriorated despite these measures.
Results: Forty -one (26%) developed BK viremia; 27 (16%) of whom had significant viremia. A total of seven (25%) of the 25 (of 27) patients who underwent biopsy had BKVAN with positive SV 40 staining. The mean plasma BKV PCR reduced by 91% (range, 52%-100%) at 24 weeks after peak viremia. Acute cellular rejection seen in 02 (07%) of 27 patients, responded to bolus steroids. The median FK 506 level in patients with BKVAN was 8.5 ± 1.2 ng/mL. The actuarial graft survival rate in patients with BKVAN was 100%, 98%, 96% and at the death censored graft survival rate was 100%, 100%, 98% at 6, 12, 18 months post renal transplant. There was no significant decline in mean creatinine clearance at 1 month after transplantation to 1 year after peak viremia (P=0.67). There was no statistical correlation in development of significant BK Viremia with CMV infection (p=0.81), Cold Ischemia Time (p=0.06) or Alemtuzemab induction (p=0.09).
Conclusions: BK viremia was controlled with reduction in immunosuppression in majority of patients. Nearly 10% patients had significant viremia, 4.5% patients had BKVAN and 1.2% patients had graft loss in the our screened population. PCR monitoring for BK viremia, together with a protocol decrease in immunosuppression, effectively reduces rates of BKVAN and graft loss. Our BK viremia rate was similar to the majority of published reports.
To cite this abstract in AMA style:Sharma H, Wong C, El-Bakry A, Sinha R, Abunabi K, Howse M, Ridgway D, Mehra S, Sharma A, Hammad A. Strict Adherence to Prospective BK Virus Screening Protocol Reduces BK Virus Induced Nephropathy and Subsequent Graft Loss but Not the BK Viremia [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/strict-adherence-to-prospective-bk-virus-screening-protocol-reduces-bk-virus-induced-nephropathy-and-subsequent-graft-loss-but-not-the-bk-viremia/. Accessed June 4, 2020.
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