Role of BK virus infection in end‐stage renal disease patients waiting for kidney transplantation – viral replication dynamics from pre‐ to post‐transplant

Abstract

We report the prevalence of BK virus (BKV) infection before renal transplantation and the dynamics of BKV viremia from pre- to post-transplantation. We assessed 60 kidney transplanted patients from a single cohort in Italy, treated with identical immunosuppressive therapy, for BK viremia at pre-transplantation, 12 h, and three and six months post-transplantation. Polymerase chain reaction showed that the prevalence of plasma BKV replication--considered a marker of infection--was 20% in pre-transplant patients. All pre-transplant-positive patients remained positive post-transplant, whereas the majority of pre-transplant-negative patients remained negative. Viremia dynamics classification revealed three clusters of patients: Cluster A++, pre-transplant-positive patients (20%) who tested positive at least once post-transplant; Cluster B-+, pre-transplant-negative patients (28%) who tested positive at least once post-transplant; and Cluster C- -, pre-transplant-negative patients (52%) who remained negative throughout. These clusters presented significant differences related to the prevalence of substantially positive patients with high plasma viral load (>10(3) copies/mL) in cluster A, but not in donors' or grafts' characteristics. We suggest that pre-transplant viral status should be considered as an additional risk factor for post-transplant BKV replication. Therefore, pre-transplant BKV infection screening in kidney transplant patients should be performed for improving planning of personalized immunosuppressant schemes and specific post-transplant surveillance.

Increased incidence of BK virus viraemia among patients undergoing chronic haemodialysis: a case–control study

“…For instance, in Iran, BKV viraemia was not reported among chronic HD subjects, was found among 3% of peritoneal dialysis subjects7 and was found among 15.7% of kidney transplanted subjects 12. In Italy, a reported 20% of HD subjects had BKV viraemia just prior to undergoing kidney transplantation 8. In Tunisia, BKV viraemia was found among 5.5% of subjects post-kidney transplantation, but not among healthy controls 13…”

Factors Contributing to Kidney Allograft Loss and Associated Consequences among Post Kidney Transplantation Patients

“…The recipient's immune characteristics as well as posttransplant immunosuppressive drugs such as Tacrolimus and mycophenolate mofetil are considered as the greatest risk factors for BK Viral Nephropathy (BKVN) onset [74,75] that causes graft loss in renal transplant. Patients post kidney transplantation is prone to severe infections.…”

“…Patients post kidney transplantation is prone to severe infections. According to Mitterhofer et al [75] factors such as local injury/regeneration with variable tissue permissiveness as well as recipient and donor characteristics may be capable of favouring BKV replication. According to Smedbraten et al [76] previous studies have shown that cytomegalovirus (CMV) infection is associated with shorter renal graft survival and increased risk of post-transplant CMV Diabetes Mellitus.…”

BK virus nephropathy in renal transplant recipients

“…On the other hand, several reports suggest reactivation of BKV in the recipient. Mitterhofer et al . studied the prevalence and dynamics of BKV pre‐transplant and post‐transplant.…”