Abstract: TH-PO844
A Comparison of BK Polyomavirus Nephropathy Between Native and Allograft Kidneys
Session Information
- Transplantation: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Wu, Tong, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Yang, Shicong, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Chen, Wenfang, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
Background
BK polyomavirus nephropathy (BKVN) has emerged as an important but uncommon cause of renal dysfunction and loss in allograft kidney and native kidneys from hematopoietic stem cell transplant recipients (HSCTRs). Yet it is unclear whether there is difference between these two populations on the clinicopathological features and renal outcomes.
Methods
Patients diagnosed as BKVN by renal biopsy from 2019 to 2022 were collected for a retrospective cohort study. The patients were divided into native kidney group (including 7 HSCTRs) and allograft kidney group (including 50 KTRs).
Results
By the time of diagnosis, the median age of native kidney group was younger than that of allograft kidney group (median 14.4 vs. 35.3y, P<0.001). There was no difference of time interval from transplantation to diagnosis between the two groups (median 12.0 vs. 11.0 months, P=0.742). The native kidney group had higher i, ci, ct scores (Banff 2019) and percentage of SV40-T positive tubules (all P<0.05). More positive SV40-T glomerular parietal epithelial cells was found in native than in allograft kidney group (P<0.05). In a 1:1 propensity score matching by age, the native kidney group also showed higher i score, higher proportion of SV40-T positive tubules and advanced AST stage patients than allograft kidney group (all P<0.05). The rate of eGFR decline was greater in native than allograft kidney group (median -1.82 vs.0.44 ml/min per 1.73 m2/year, P=0.044; Fig A). One year cumulative renal failure rate after BKVN diagnosis was 57.1% in native and 4% in allograft kidney group (P<0.001; Fig B). The risk of progression to renal failure was significantly higher in BKVN of native than BKVN of allograft kidney (HR, 0.02; 95% CI, 0.00-0.59; P=0.025). Multivariate Cox regression analysis demonstrated that advanced AST stage was independently associated with worse renal outcome (HR, 2.36; 95% CI, 1.05-5.33; P=0.038).
Conclusion
BKVN of native kidneys in HSCTRs have a poorer renal survival than allograft kidney, which may correlate with more severe tubulointerstitial chronic lesions and higher tissue polyomavirus load at the time of renal biopsy.