Development of BK Nephropathy in Recipients of Simultaneous Pancreas-Kidney Transplantation

Abstract

BKVN occurs in 5.6% of SPK recipients. There is no difference in the cumulative rate of BKVN between patients who received alemtuzumab or rabbit antilymphocyte globulin.

BK Virus Replication and Nephropathy After Alemtuzumab-Induced Kidney Transplantation

“…Epidemiologic studies estimate that BK viruria, viremia and nephropathy occur in 30%, 13% and 8% of patients at 16, 23 and 28 weeks after renal transplantation, respectively (1). Only 2 of 21 epidemiologic studies have evaluated BKV infection as a primary endpoint in the setting of alemtuzumab induction and these studies were unable to elucidate specific risk factors for BKVN (2,3). As a result, the relative impact of this potent lymphocyte-depleting agent on the epidemiology of BKVN remains poorly defined.…”

Clinical characteristics and outcomes of late‐onset BK virus nephropathy in kidney and kidney‐pancreas transplant recipients

“…Fourteen studies included adequate data to calculate the proportion of late BKPyVAN, defined as >1 year post‐transplant (Table ) . Among studies evaluating KTRs, 36.4% of BKPyVAN (27 of 74) occurred late (median 9.1 months post‐transplant, range 1‐113 months).…”

“…An independent analysis of time to diagnosis of BKPyVAN was performed for all evaluable studies. Only those cohort studies in which the proportion of late‐ and early‐onset BKPyVAN could be accurately determined based on the data provided in the published paper were included in Table …”

“…Of 2 prior studies that reported on late‐onset BKPyV, both defined “late‐onset” as BKPyV infection/disease that occurred after 6 months post‐transplant . This definition of “late‐onset” is problematic both because the mean/median onset of BKPyVAN is often later than 6 months and because all major guidelines recommend routine BKPyV screening up to 1 year post‐transplant. Recent studies have documented the histological evolution of BKPyVAN and have noted isolated late cases occurring >2 years post‐transplantation .…”

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“…Alemtuzumab does not increase rates of BK viruria, BK viremia, or BKV nephropathy compared with that shown with nonlymphocyte-depleting therapy. [47][48][49] Cyclosporine is believed to be associated with a lower incidence of BKV nephropathy than tacrolimus, and mycophenolate mofetil is associated with a higher incidence of treatment for BKV compared with no antimetabolite therapy or azathioprine. 9,50-52 Whereas Retrospective cohort study 666 patients from January Induction with Alemtuzumab did not increase et al 49 2008 to August 2010 alemtuzumab vs the incidence of BK virus non-lymphocyte-depleting reactivation agents Abbreviations: BKVAN, BK virus-associated nephropathy; MMF, mycophenolate mofetil; OPTN, Organ Procurement and Transplantation Network; SRTR, Scientific Registry of Transplant Recipients data on mammalian target of rapamycin inhibitors, sirolimus and everolimus, are limited, it would be safe to state that they are not associated with an increased risk of BKV nephropathy.…”