Kidney Week

Abstract: PO2454

Risk Factors for Detrimental Progression in Kidney Transplant Recipients with BK Viremia

Session Information

• Transplant Complications: Infection
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Kharel, Abish, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Abish Kharel,

• Djamali, Arjang, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Arjang Djamali,

• Jorgenson, Margaret R., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Margaret R. Jorgenson,

• Alzoubi, Beyann, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Beyann Alzoubi,

• Swanson, Kurtis J., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Kurtis J. Swanson,

• Garg, Neetika, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Neetika Garg,

• Aziz, Fahad, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Fahad Aziz,

• Mohamed, Maha A., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Maha A. Mohamed,

• Mandelbrot, Didier A., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Didier A. Mandelbrot,

• Parajuli, Sandesh, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Sandesh Parajuli,

Background

The only effective management for BK viremia (BKV) among kidney transplant recipients (KTR) is regular monitoring and adjustment of immunosuppression. With this strategy, the majority of patients will clear BK or have low-level persistent BKV (Group A). However, few will transition toward over-immunosuppression [BKV level > 5 log₁₀ copies/ml or BK nephropathy (BKN) (Group B)], or under-immunosuppression [de novo DSA (dnDSA) or acute rejection (AR) (Group C)]. In this study, we sought to find the characteristics of patients who progress to group B or group C.

Methods

It was a prospective study among KTR transplanted at our University hospital between 01/2015 and 12/2017. All KTR who developed BKV (> 3 log₁₀ copies/ml) within 2 years of transplant were included in the study. Patients were followed up to 2 years of transplant and were divided into 3 groups as above, based on the BK levels or other outcomes. Those patients with progression of BK >5 log₁₀ copies/ml or BKN along with dnDSA or AR, were assigned to the Group B or Group C, whichever event occurred first.

Results

A total of 224 KTR fulfilled our selection criteria, of which 118 (53%) remained in group A, while 64 (28%) and 42 (19%) transitioned to groups B and C, respectively. Compared to group A, in multivariate analysis, female (HR 2.05, 95% CI: 1.08-3.90, p=.02), rejection before BKV (HR 2.90, 95% CI: 1.04-8.12, p=.04) and interval from transplant to first BKV (HR 0.81, 95% CI: 0.72-0.90, p=<0.001) were associated with transition to group B. Conversely, basiliximab induction (HR 2.06, 95% CI: 1.03-4.11, p=.03), HLA mismatch > 3 (HR 2.27, 95% CI: 1.01-5.06, p=.04) and DGF (HR 4.14, 95% CI: 1.12-15.3, p=.03), were associated with progression to group C. At 2 years, graft failure rates were similar between the groups. However, among those with functional graft, group A had significantly better graft function with eGFR of 62 ml/min compared to 46 for group B and 50 for group C.

Conclusion

Our study suggests that in KTR with BK viremia, nearly 50% progress unfavorably toward a state of under-immunosuppression (AR) or over-immunosuppression (worsening BK). Modifiable risk factors including history of rejection, induction therapy, HLA mismatch, and DGF could help preventing untoward disease progression.