BK Polyomavirus‐associated nephropathy managed by screening policy in a real‐life setting

Abstract

Background BK polyomavirus‐associated nephropathy (PyVAN) is an important complication after kidney transplantation. Prevalence ranges from 1% to 10%, and graft loss occurs in approximately 50% of the cases. There is no effective treatment, so early viral detection with immunosuppression tapering is the current strategy to prevent PyVAN. Aims To verify the frequency of PyVAN in a single center and evaluate the response to immunosuppressive adjustments through graft survival analysis. Methods Retrospective evaluation of a cohort of kidney transplant recipients with biopsy‐proven PyVAN, compared with no‐PyVAN patients regarding clinical aspects, immunosuppression, and graft survival over at least 2 years. Results There were 1404 kidney transplants analyzed in the study period, 58 with biopsy‐proven PyVAN. Cumulative incidence was 4.1%. Median time from transplantation to PyVAN diagnosis was 6 (1‐41) months. PyVAN was associated with recipient male gender (P = .041) and deceased donation (P = .005). Graft survival was inferior for PyVAN compared to no‐PyVAN patients, 81.8% vs 75.2%, P = .019. Thirteen (22.4%) PyVAN patients lost their grafts, nine (15.5%) losses attributed to BKPyV infection. Three patients with BKPyV‐associated graft losses were submitted to a successful second kidney transplant, with no evidence of viral replication during follow‐up. Conclusion PyVAN still is an important cause of kidney graft failure. Even though implementing active vigilance and immunosuppressive adjustment, this real‐life single‐center study demonstrated inferior graft survival in PyVAN patients compared to non‐PyVAN.

A Single Center's Experience with BK-Virus Frequency in Post-Renal Transplant Patients in IKD Peshawar

“…As a rule, the disease is asymptomatic until it has spread to other organs. It's possible that the BK virus will stay dormant after an asymptomatic infection in several bodily parts, including the renal tubular epithelium 2 . Reactivation of the virus and graft malfunction occur when the immune response is reduced, as in renal transplant patients who have had therapeutic immunosuppression 3 .…”

Human genes with relative synonymous codon usage analogous to that of polyomaviruses are involved in the mechanism of polyomavirus nephropathy

“…The infection of kidney tissues by HPyVs is associated with complications such as PVAN and allograft rejection. BKPyV can simultaneously induce inflammatory and fibrotic responses, immunosuppression, and tubular injury in kidney transplants, thereby causing kidney transplant rejection in 40–70% of infected grafts ( Babel et al., 2011 ; Ambalathingal et al., 2017 ; Raupp et al., 2020 ; Kotla et al., 2021 ; Shen et al., 2021 ). JCPyV-associated PVAN occurs in <3% of PVAN cases after renal transplantation ( Kantarci et al., 2011 ; Yang et al., 2017 ; Höcker et al., 2018 ).…”