Association of donor hepatitis C virus infection status and risk of BK polyomavirus viremia after kidney transplantation

Abstract

Kidney transplantation (KT) from deceased donors with hepatitis C virus (HCV) into HCV‐negative recipients has become more common. However, the risk of complications such as BK polyomavirus (BKPyV) remains unknown. We assembled a retrospective cohort at four centers. We matched recipients of HCV‐viremic kidneys to highly similar recipients of HCV‐aviremic kidneys on established risk factors for BKPyV. To limit bias, matches were within the same center. The primary outcome was BKPyV viremia ≥1000 copies/ml or biopsy‐proven BKPyV nephropathy; a secondary outcome was BKPyV viremia ≥10 000 copies/ml or nephropathy. Outcomes were analyzed using weighted and stratified Cox regression. The median days to peak BKPyV viremia level was 119 (IQR 87–182). HCV‐viremic KT was not associated with increased risk of the primary BKPyV outcome (HR 1.26, p = .22), but was significantly associated with the secondary outcome of BKPyV ≥10 000 copies/ml (HR 1.69, p = .03). One‐year eGFR was similar between the matched groups. Only one HCV‐viremic kidney recipient had primary graft loss. In summary, HCV‐viremic KT was not significantly associated with the primary outcome of BKPyV viremia, but the data suggested that donor HCV might elevate the risk of more severe BKPyV viremia ≥10 000 copies/ml. Nonetheless, one‐year graft function for HCV‐viremic recipients was reassuring.

Kidney transplant from hepatitis C viremic donors into aviremic recipients and risk for post‐transplant BK and cytomegalovirus infection

“….03) 43 . The author suggested that kidney transplant recipients from In conclusion, HCV-negative kidney transplant recipients who receive organs from HCV-viremic donors do not appear to be at increased risk for post-transplant viral complications when DAAs therapy is started within the first month after transplant.…”

“…In an earlier report by Molnar et al., evaluating the risk of BK viremia in HCV‐negative kidney transplant recipients of HCV NAT+ kidneys, the group found no difference in the primary outcome of incidence of any BK viremia between the groups. However, in their experience, kidney transplantation from HCV NAT+ donors was associated with an increased risk for BK viremia ≥10 000 copies/ml (HR = 1.69, p = .03) 43 . The author suggested that kidney transplant recipients from HCV NAT+ donors might have more difficulty in clearing BK viremia once developed.…”

Utilization of HCV viremic donors in kidney transplantation: a chance or a threat?

“…did not prove the association between donor-derived HCV viremia and CMV viremia, whereas the more recent study by Molnar et al. found that KTRs undergoing HCV NAT D+/R- transplant may be at increased risk of developing high-level BK viremia [ 65 , 66 ]. In the THINKER and EXPANDER studies, no serious complications were observed in the early posttransplant period [ 26 , 41 , 42 ].…”

Kidney Transplantation From Hepatitis-C Viraemic Donors:Considerations for Practice in the United Kingdom

“…Concerns have also been raised regarding the increased risk of the development of BK viraemia and cytomegalovirus (CMV) and severe cases have coincided with the formation of de novo donor specific antibodies ( 32 , 36 ). Studies to date have not noted significant difference in the prevalence of such viral complications, but when such events occur, the severity has been increased ( 36 , 37 ). Consequently, thorough surveillance strategies will be required.…”