Low Incidence of BK Virus Nephropathy After Simultaneous Kidney Pancreas Transplantation

Abstract

There was a relatively lower incidence of BKVAN among SKPT patients at our center. Although overall graft loss rate was comparable to other series, BKVAN patients had a slightly prolonged graft life. The BKVAN incidence was further reduced in patients receiving modified immunosuppression with antibody preconditioning. The underlying reasons may include less toxic immunosuppressive protocols, earlier diagnosis and the use of antiviral therapy.

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

“…The overall 5-year rate of BKVN of 5.6% in this study is consistent with the incidence documented in previous studies (2)(3)(4)(5)(6). Our patients typically developed BKVN late (mean 20 months posttransplant); the mean diagnosis of BKVN in previous studies ranged from 12 to 19 months posttransplant (4,5). None of our patients had loss of pancreatic function, whereas pancreatic dysfunction occurred in 28% in one study (4).…”

“…Our patients typically developed BKVN late (mean 20 months posttransplant); the mean diagnosis of BKVN in previous studies ranged from 12 to 19 months posttransplant (4,5). None of our patients had loss of pancreatic function, whereas pancreatic dysfunction occurred in 28% in one study (4). This is the largest experience of BKVN in SPK patients who received alemtuzumab to be reported in the literature.…”

“…In the few published studies, the incidence of BK DNAemia among pancreas-kidney recipients has ranged from 0% to 20%, (2,3) whereas the incidence of BKVN in this population ranged from 2.9% to 15% (3)(4)(5)(6). Reduction of maintenance immunosuppression, which is considered central to the management of BKVN, may result in rejection of the pancreas among recipients of combined transplants (7).…”

BKV-infection in kidney graft dysfunction

“…[3][4][5][6] BKN has been associated with graft dysfunction in 3% to 14% of kidney recipients, leading to graft failure in up to 67% of the cases. 2,7,8 Specifi c diagnosis of BKN depends on the pathological tissue patterns on the graft biopsy specimen, which can be confounded with cellular rejection mainly when both pathologies coexist. Thus, BKN diagnosis, based exclusively on the pathological criteria, might be diffi cult.…”

“…Thus, BKN diagnosis, based exclusively on the pathological criteria, might be diffi cult. [4][5][6][7][8][9][10][11] This study was designed to investigate the prevalence of BKV infection among patients under late kidney graft dysfunction. It combines three non-invasive methodologies: urinary cytology (looking for decoy cells; DC), viruria (urinary viral DNA), and viremia (active infection; blood viral DNA), and takes into consideration the importance of an early diagnosis and the need of graft biopsy invasiveness to defi ne a suspicion of BKN.…”