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Abstract: SA-PO826

BK Polyomavirus (BKPyV) and Cytomegalovirus (CMV) Infections in Kidney Transplantation (KT) From Hepatitis C Positive (HCV) Viremic Donors to Uninfected Recipients

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Amrutiya, Viralkumar, Virginia Commonwealth University, Richmond, Virginia, United States
  • Yakubu, Idris, Virginia Commonwealth University, Richmond, Virginia, United States
  • Moinuddin, Irfan Ahmed, Virginia Commonwealth University, Richmond, Virginia, United States
  • Levy, Marlon F., Virginia Commonwealth University, Richmond, Virginia, United States
  • Gupta, Gaurav, Virginia Commonwealth University, Richmond, Virginia, United States
  • Azhar, Ambreen, Virginia Commonwealth University, Richmond, Virginia, United States
Background

KT from HCV viremic donor to uninfected recipients (D+/R-) is becoming more common across United States. Recent ‘transmit-and-treat’ studies suggest that donor HCV might be associated with an increased risk of BKPyV and CMV infections due to the suppression of host immune response by HCV. We have previously reported HCV transmission rate of only 9% with ultra-short pangenotypic Direct Acting Antiviral prophylaxis (DAA) of 2-7days. Here we report the incidence of BKPyV and CMV infections in this cohort in comparison with a matched cohort (1:1) of HCV D-/R- KT recipients.

Methods

All patients received rabbit anti-thymocyte globulin followed by tacrolimus, mycophenolate and prednisone. D-/R- recipients (controls) were matched with cases (D+/R-) in a 1:1 distribution based on; waitlist time, ‘kidney-only’ transplant with ≤1 previous organ transplant, pre-transplant diabetes, Expected Post Transplant Survival category in four quantiles, calculated Panel Reactive Antibodies <50%; negative crossmatch, and Donor Specific Antibodies (DSA) at transplant ≤3000 MFI.

Results

A total of 102 D+/R- transplants were included as; Group 1 (2-4d prophylaxis (ppx); N=52) and Group 2 (7d ppx; N=50). All 9 patients that developed viremia achieved sustained virologic response post-full course DAA. Controls were more likely to be African American (73% vs 59%; p=0.04), with pre-formed DSAs (13% vs 3%, p=0.02) and higher Kidney Donor Profile Index (66 vs 56, p=0.001) compared to the cases. Recipients of HCV D+/R- had equivalent CMV infection (14% vs 14%, p=1.0) but less CMV disease vs controls (71% vs 29%, p=0.05) amongst those who developed viremia. There was a numerically higher incidence of any BKPyV infection (20% vs 12%, p=0.12), and high plasma titer BKPyV ≥10000 (12% vs 6%, p=0.21) in the D+/R- group compared with D-/R- group that did not reach statistical significance.

Conclusion

We did not find increased risk of CMV infections however numerical trend for increased BKPyV was seen predominantly in patients without HCV replication in (D+/R-) recipients suggesting either lack of HCV replication may be protective against CMV, or apparent increased risk of opportunistic viral infections due to unmeasured confounders in patient selection.