Abstract: SA-PO1131
Comparison of Low-Dose vs. High-Dose Intravenous Immunoglobulin for BK Virus Infection in Kidney Transplant Recipients: A Single-Center Experience
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Soman, Sana S., Wayne State University School of Medicine, Detroit, Michigan, United States
- Fitzmaurice, Mary Grace, Henry Ford Health System, Detroit, Michigan, United States
- Prashar, Rohini, Henry Ford Health System, Detroit, Michigan, United States
Background
BK polyomavirus (BKV) contributes to allograft dysfunction after kidney transplant. Immunosuppression reduction is standard; IVIG is used as adjunct therapy, but the optimal dose is unknown. We compared low-dose (0.5 g/kg) vs high-dose (1 g/kg) IVIG for BK viremia.
Methods
Retrospective review of 15 kidney transplant recipients (KTRs) treated with IVIG for BK viremia was done. We compared patients who received low-dose 0.5 g/kg (n=7) vs high-dose IVIG 1 g/kg (n=8). Immunosuppression was reduced before IVIG initiation in both groups. Primary outcome was viral clearance at 12 months (undetectable BK viral load). Secondary outcomes were GFR change, graft loss within 1 year, and costs.
Results
Baseline characteristics are shown in Table 1. Compared with the low-dose group, high-dose KTRs had higher KDPI kidneys (median 75.5 vs 27.0) and lower baseline GFR (47.5 vs 63.0 mL/min). The low-dose group received more total doses over 1 year (mean 11 vs 8). Viral clearance at 12 months was higher with high-dose IVIG (62.5% vs 28.6%). Graft loss occurred in 25% of high-dose recipients vs 0% with low-dose, consistent with higher baseline risk. Median GFR change was small in both groups (-1.2% vs 1.1%). Mean total cost for IVIG over 1 year per patient was similar ($28,190 in high-dose vs $29,238 in low-dose).
Conclusion
High-dose IVIG was associated with higher viral clearance, but a higher rate of graft loss. However, the high-dose cohort had higher KDPI kidneys and lower baseline GFR which may have influenced graft outcomes. Total costs were similar due to more frequent doses in the low-dose group, suggesting high-dose IVIG may be more cost-effective for viral clearance. Larger studies are needed to determine optimal IVIG dosing in BK viremia.