In kidney transplant recipients with BK polyomavirus infection, early BK nephropathy, microvascular inflammation, and serum creatinine are risk factors for graft loss

Abstract

These observations suggest that, in patients with BK infection, early BKVN, Scr >2, and MVI are predictors of poor outcomes. Further studies are needed to determine effective treatment strategies for BKVN, with or without AMR.

De novo donor‐specific antibody following BK nephropathy: The incidence and association with antibody‐mediated rejection

“…Study of the histologic evolution of BK nephropathy has recently shown the link between BK nephropathy and antibody‐mediated rejection, but in both studies were limited by their lack of standardized de novo DSA screening . Previous work has shown that features of antibody‐mediated rejection (glomerulitis and peritubular capillaritis) in the setting of BK nephropathy are predictors of graft loss …”

“…27,28 Previous work has shown that features of antibody-mediated rejection (glomerulitis and peritubular capillaritis) in the setting of BK nephropathy are predictors of graft loss. 29 The association between medication nonadherence and dnDSA has been well-documented, 15,18,19,[30][31][32] but few studies have systematically examined the relationship between physician directed immunosuppression reduction for infectious disease reasons and subsequent development of dnDSA. 33 immunosuppression reduction.…”

Kidney transplant recipients with polycystic kidney disease have a lower risk of post‐transplant BK infection than those with end‐stage renal disease due to other causes

“…The protocol for laboratory monitoring of BK viremia and adjustment of immunosuppression at our center was performed as previously described. 3,12 Briefly, plasma BK PCR was monitored every 2 weeks for the first 3 months post-transplant, then monthly until 6 months post-transplant, and then every 3 months until 18 months post-transplant. Allograft biopsy was performed if BK PCR was positive and/or creatinine was elevated 25% above baseline.…”

“…Risk factors for BK virus reactivation are incompletely understood, though a myriad of risk factors have been posited including characteristics pertaining to the graft, recipient, and type of immunosuppression regimen. Graft‐related risk factors include ischemic allograft injury, prior acute rejection, degree of HLA mismatch, high BK‐specific antibody titers, and BK serologic mismatch (seropositive donor and seronegative recipient), though serologic status is not routinely clinically assessed . Recipient‐related risk factors for BK reactivation include older age, Caucasian ethnicity, and male sex .…”

“…Graft-related risk factors include ischemic allograft injury, prior acute rejection, degree of HLA mismatch, high BK-specific antibody titers, and BK serologic mismatch (seropositive donor and seronegative recipient), though serologic status is not routinely clinically assessed. 2,11,12 Recipient-related risk factors for BK reactivation include older age, Caucasian ethnicity, and male sex. 8,13 It is currently unknown whether the cause of ESRD affects BK viral reactivation or nephropathy.…”