Which Is More Nephrotoxic to Kidney Transplants: BK Nephropathy or Rejection?

S. Parajuli, B. Astor, D. Kaufman, B. Muth, M. Mohamed, N. Garg, A. Djamali, D. Mandelbrot.

University of Wisconsin, Madison

Meeting: 2017 American Transplant Congress

Abstract number: A213

Keywords: Polyma virus, Rejection

Session Information

Session Name: Poster Session A: Kidney: Polyoma

Session Type: Poster Session

Date: Saturday, April 29, 2017

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall D1

The relative nephrotoxicity of BK nephropathy (BKN) vs acute rejection is unknown. This is an important question, since clinicians often must choose between reducing immunosuppression and risking rejection vs increasing immunosuppression and risking BKN.

We reviewed outcomes in recipients of kidney transplants between1/1/2000 and 06/30/2013 who had a first time diagnosis of biopsy-proven BKN or rejection between 1-18 months post-transplant.

There were 96 cases of BKN and 256 cases of rejections. 83 had antibody mediated (AMR), 111 had cellular (ACR) and 62 had mixed rejections. We compared outcomes of BKN with all rejections combined. Among the baseline characteristics, the BKN group had a lower proportion of females and patients with glomerulonephritis. There were no differences in age, race, deceased donor transplant, prior transplants, delayed graft function rate or mean interval from transplant to the event. There were no differences between the BKN and rejection groups for best serum Cr (Scr), or Scr at the time of event. However, the Scr were worse in the BKN group at 6 and 12 months as well as 3 years after the event.

Data	BKN (n=96)	Rejection (n=256)	P Value
Mean nadir serum creatinine (mg/dl)	1.35± 0.42	1.25±0.52	0.09
Mean serum creatinine at time of diagnosis (mg/dl)	2.37± 0.86	2.11±1.33	0.09
Mean serum creatinine at 6 months (mg/dl)	2.69±1.54	1.80±0.92	<0.001
Mean serum creatinine at 12 months (mg/dl)	2.40±1.36	1.70±0.85	<0.001
Mean serum creatinine at 3 years (mg/dl)	2.08±0.97	1.62±0.75	0.001

We also analyzed rejection by AMR, ACR and mixed and found the same results. The median follow-up was 1219 days for the BKN group and 866 days for the rejection group (P=0.001) There were a total of 57 graft losses (42 death censored, D-C) in BKN and 100 (74 D-C) in rejection group. The D-C graft failure incidence rate (/100 pt-years) was 11.7 in BKN and 11.3 in rejection (p=0.85). Mean time to D-C graft loss was 1142±1205 in BKN and 787±818 days in rejection (p=0.06).

While the difference in rate of graft loss between BKN and rejection did not reach statistical significance, kidney function for the three years after diagnosis was worse for BKN than for rejection, suggesting that BKN may be more nephrotoxic.

CITATION INFORMATION: Parajuli S, Astor B, Kaufman D, Muth B, Mohamed M, Garg N, Djamali A, Mandelbrot D. Which Is More Nephrotoxic to Kidney Transplants: BK Nephropathy or Rejection? Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Parajuli S, Astor B, Kaufman D, Muth B, Mohamed M, Garg N, Djamali A, Mandelbrot D. Which Is More Nephrotoxic to Kidney Transplants: BK Nephropathy or Rejection? [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/which-is-more-nephrotoxic-to-kidney-transplants-bk-nephropathy-or-rejection/. Accessed May 25, 2025.

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