Correlation between donor acute kidney injury and recipient BK viruria after surgery

Abstract

Background Donor acute kidney injury (AKI) may provide more donor kidney sources to organ banks and provide more transplant opportunities for patients suffering from kidney failure. The BK virus normally resides in the human body and is more likely to be activated in kidney transplant recipients. BK viruria occurs following the infection of kidney transplant recipients with the BK virus (BKV); this is followed by BK viremia. When BKV reaches the transplanted kidney, it will increase the probability of renal graft loss. Few studies have investigated the relationship between donor AKI and recipient BK viruria. In this study, we investigated the relationship between donor AKI and recipient BK viruria to provide more donor kidney sources for kidney transplantation. Methods We performed retrospective analysis on 338 kidney transplant recipients in our hospital between 2018 and 2021. These were divided into a BK viruria group and a non-BK viruria group. The initial donor and kidney transplantation characteristics of the two groups were evaluated, and the association between donor AKI and BK viruria was analyzed by univariate, multivariate and subgroup analysis. Results At the median follow-up time of 826 days (range: 527–1176) days, 55 of renal transplantation patients developed BK viruria; thus, the incidence of BK viruria was 16.3%. Approximately, 47.3% of BK viruria occurred within six months after kidney transplantation. Compared with the non-BK viruria group, the age (58[48,64] vs 53[45,60], P = 0.014), Kidney Donor Profile Index (KDPI) (0.83[0.70, 0.92] vs 0.71[0.49, 0.87], P = 0.005)and Kidney Donor risk Index (KDRI) (1.42[1.22, 1.66] vs 1.24[0.99, 1.50], P = 0.005) of the corresponding donor were higher, the sCr before kidney transplantation(814.00 [640.50, 1085.00] vs 983.00 [781.00, 1194.00], P = 0.006), along with the proportion of patients with a Panel Reactive Antibodies (PRA) > 10% prior to surgery (5.5% vs 17.3%, P = 0.024), and the serum creatinine (sCr) 21 days after surgery (94.00 [78.00, 115.50] vs 105.00 [83.00, 136.50], P = 0.04) in the recipient were lower, and the Estimated Glomerular Filtration Rate (eGFR) prior to surgery (5.19 [4.06, 8.09] vs 4.61 [3.72, 6.32], P = 0.016) was higher. No independent association was detected between donor AKI and BK viruria by univariate, multivariate, or subgroup analyses. Conclusions In this single-center study, we found that there was no correlation between donor AKI and postoperative BK viruria with regards to donor after cardiac death (DCD). Thus, AKI donor kidneys can be used to alleviate organ shortages.