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Kidney Week

Abstract: PO2350

Reduced 1-Year Allograft Function in Pediatric Renal Transplant Patients: Role of Subclinical Viral Replications

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Dandamudi, Raja, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, United States
  • Hmiel, Stanley P., Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, United States
  • Dharnidharka, Vikas R., Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, United States
Background

BK virus (BKV) and Epstein-Barr virus (EBV) subclinical viral replications (SVR) are common after renal transplant. The effects of SVR on the GF in pediatric kidney transplant (pKTx) recipients is not well defined and was the purpose of this study.

Methods

This retrospective study was done in our hospital from Jan 2012 to Dec 2018. 480 serum and urine samples from 39 pKTx were analyzed for viral load by quantitative PCR through the first post-transplantation year. Clinical characteristics, including GF by estimated glomerular filtration rate (eGFR) via bedside Schwartz formula were collected simultaneously. Analysis of differences between GF in patients with and without SVR was performed with t test and differences of P < 0.05 was significant.

Results

SVR occurred in 23/39(59%) of pKTx. EBV SVR occurred in 13/39(33%) pKTx at a mean (M) 95.8 days after transplantation (range(R) 14 to 220 days). M EBV level was 9188copies/ml (R 2K to190K copies/ml). BK viremia occurred in 10 pKTx at a M 132 days after transplantation (R 11 to 276 days) with a M level 49769 copies/ml (R 2K to 1,610K copies/ml). BK viruria occurred in 18 pKTx at a M 83 days after transplantation (R 11 to 230 days) with a M level 22,339,360 copies/ml (R 5K to 100,000K copies/ml).
There was a significant difference in GF decline in patients with any SVR (M 21.97, SD 26.29) compared to patients with no SVR (M 2.1, SD 27.23), p 0.013.
Patients with subclinical EBV/BK viremia and BK viruria experienced a M decrease of 28.9 (SD 29.78) and 40.72 (SD 38.06), and 16.53 (SD15.33) respectively, in GF during the 1-year period follow up.In patients with combined BK viremia, viruria and subclinical EBV RA experienced a M decrease in GF of 7.51 (SD 15.57) a year after transplantation.

Conclusion


BKV and EBV SVR significantly impacted the GF 1-year post transplant and therefore likely on long-term GF. Multicenter studies are required to study whether combined SVRs have more serious impact on GF than the corresponding mono SVR.