Incidence and Outcomes of BK Virus Allograft Nephropathy among ABO- and HLA-Incompatible Kidney Transplant Recipients

Abstract

SummaryBackground and objectives ABO-incompatible kidney transplant recipients may have a higher incidence of BK virus allograft nephropathy (BKVAN) compared with ABO-compatible recipients. It is unclear whether HLAincompatible recipients share this risk or whether this phenomenon is unique to ABO-incompatible recipients.Design, setting, participation, & measurements This study analyzed adult incompatible kidney transplant recipients from 1998 to 2010 (62 ABO-incompatible and 221 HLA-incompatible) and identified patients in whom BKVAN was diagnosed by biopsy (per protocol or for cause). This was a retrospective analysis of a prospectively maintained database that compared BKVAN incidence and outcomes between ABO-and HLA-incompatible recipients, respectively. BKVAN link to rejection and graft accommodation phenotype were also explored. The Johns Hopkins Institutional Review Board approved this study.Results Risk for BKVAN was greater among ABO-incompatible than HLA-incompatible patients (17.7% versus 5.9%; P=0.008). Of BKVAN cases, 42% were subclinical, diagnosed by protocol biopsy. ABO-incompatibility and age were independent predictors for BKVAN on logistic regression. C4d deposition without histologic features of glomerulitis and capillaritis (graft accommodation-like phenotype) on 1-year biopsies of ABO-incompatible patients with and without BKVAN was 40% and 75.8%, respectively (P=0.04). Death-censored graft survival (91%) and serum creatinine level among surviving kidneys (1.8 mg/dl) were identical in ABO-and HLAincompatible patients with BKVAN (median, 1399 and 1017 days after transplantation, respectively).Conclusions ABO-incompatible kidney recipients are at greater risk for BKVAN than HLA-incompatible kidney recipients. ABO-incompatible recipients not showing the typical graft accommodation-like phenotype may be at heightened risk for BKVAN, but this observation requires replication among other groups.

Risk for BK Viremia and Nephropathy After Desensitization

“…There were 28 patients who received an ABO-incompatible allograft during the same study period. There was less BKV viremia in patients undergoing ABO-incompatible transplant (3.5% vs. 20%; P=0.03) which is different from what was previously reported (2). This is interesting because both HLA-sensitized and ABO-incompatible recipients undergo a similar regimen and maintenance immunosuppression.…”

“…We have previously demonstrated that patients who are desensitized just before surgery (plasma exchange with low dose IVIGTrituximab/splenectomy) have higher rates of BK nephropathy compared to compatible kidney allograft recipients (2). In this retrospective analysis of a prospectively maintained cohort, ABO-incompatible (n=62) and HLA-incompatible (transplantation across preformed donor-reactive antibodies, n=221) kidney allograft recipients had BK nephropathy rates of 17.7% and 5.9%, respectively (compared to 3.0% in compatible kidney allograft cohort).…”

BK virus nephropathy in renal transplant recipients

“…quoted previously, the absence of HLA C7 among both donors and recipients was highlighted as a factor contributing to sustained BK viremia in the recipients. Sharif et al . reported that ABO‐incompatible RTR were at higher risk of developing BKVN compared with HLA‐incompatible kidney transplants.…”

“…reported that ABO‐incompatible RTR were at higher risk of developing BKVN compared with HLA‐incompatible kidney transplants. They compared 221 HLA‐mismatched RTR with 68 ABO‐I RTR during 1998–2010 and found a BKVN prevalence of 5.9% v/s 17.5%, respectively ( P = 0.08) . Although more potent immunosuppression with thymoglobulin induction, the use of Tacrolimus (Tac) and Mycophenolate (MPA) seems to be associated with increased incidence of BKVN; the contribution of individual agents is controversial .…”

BK virus infection following kidney transplantation

“…Nonetheless, both recipient and donor factors have been implicated [4][5][6][7][8][9]. Nonetheless, both recipient and donor factors have been implicated [4][5][6][7][8][9].…”