Impact of BK Polyomavirus Plasma Viral Load in Kidney Transplant Outcomes |
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| Institution: | 1. Department of Nephrology, Hospital Puerta del Mar, Cadiz, Spain;2. Department of Nephrology, Hospital Jerez de la Frontera, Cadiz, Spain;3. Department of Microbiology, Hospital Puerta del Mar, Cadiz, Spain;1. Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain;2. Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain;3. Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, Servicio Galego de Saúde (SERGAS), A Coruña, Spain;4. Hospital Universitario Marqués de Valdecilla, Santander, Spain;5. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain;6. Department of Intensive Medicine, Complejo Hospitalario Universitario de A Coruña, Servicio Galego de Saúde (SERGAS);7. Universidade da Coruña (UDC), Coruña, Spain;1. Heart Failure and Transplantation Unit, La Fe University and Polytechnic Hospital, Valencia, Spain;2. Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain;3. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain;4. Department of Medicine, Universidad de Valencia, Valencia, Spain;1. Nephrology Department, Hospital Universitario Reina Sofía, Córdoba, Spain;2. Cardiology Department, Hospital Universitario Reina Sofía, Córdoba, Spain;1. Doctoral School of Theroretical and Translational Medicine, Semmelweis University, Budapest, Hungary;2. Department of Surgery, Transplantation, and Gastroenterology, Semmelweis University, Budapest, Hungary;3. Department of General Surgery, Medical University of Vienna, Vienna, Austria;1. Liver transplantation Unit, Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain;2. Department of Pathology, Hospital Universitario Rio Hortega, Valladolid, Spain;1. Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin;2. Transplant Center, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin;3. Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin;4. Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin |
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| Abstract: | BackgroundBK polyomavirus infection (BKVi) is an important cause of kidney transplant (KT) loss, but there is scarce evidence on the impact of BK plasma viral load on graft function and long-term KT survival.MethodsA retrospective cohort study including all KT recipients with BKVi (BK viremia identified in ≥3 consecutive samples by polymerase chain reaction) in our center from January 2010 to December 2020 was performed. A case-control study (1:2) was performed. We grouped the cases according to their highest peak viral load: low-level viremia (<10,000 copies/mL) and high-level viremia (≥10,000 copies/mL). To identify risk factors for BKVi, a logistic regression analysis was achieved, and a multivariable Cox regression was used to describe risk factors for graft loss.ResultsA total of 849 KTs were performed, and 67 presented BKVi (low-level viremia, n = 35 and high-level viremia, n = 26). In logistic regression analysis male sex (odds ratio OR], 4.226; 95% CI, 1.660-10.758, P = .002), age (OR, 1.047; 95% CI, 1.008-1.088; P = .018), and retransplant (OR, 4.162; 95% CI, 1.018-17.015; P = .047) were predictors of BKVi. Acute rejection was more frequent in the BKVi group (18% vs 4.9%, P = .004), and graft survival was lower in patients with BKVi and high-level viremia (P = .027). In Cox regression analysis, BKVi (hazard ratio, 3.657; 95% CI, 1.146-11.670; P = .029) and specific BKV (BK polyomavirus) high-level viremia (hazard ratio, 1.988; 95% CI, 1.012-3.907; P = .046) were predictors of shorter graft survival.ConclusionsBKV high-level viremia was associated with BKV nephropathy and poorer graft survival. Additionally, acute rejection is more frequent after BKVi. It is necessary to develop strategies safe and effective for these patients. |
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