title: HLA mismatching increases the risk of BK virus nephropathy in renal transplant recipients.
abstract: BK virus (BKV) nephropathy is a serious complication in kidney transplant recipients that may lead to irreversible graft failure. We have analyzed the degree of donor/recipient HLA compatibility and HLA antigen association in 40 kidney transplant patients with BKV nephropathy in comparison with a control group of 404 unaffected transplant recipients who were on tacrolimus-based immunosuppression with no induction. HLA compatibility was assessed by determining the number of HLA-A, -B, -DR-mismatched antigens. BK virus nephropathy was diagnosed histologically and confirmed by immunochemistry. Univariate and multiple logistic regression statistical analyses have shown a significant association between BKV nephropathy and HLA mismatching. This analysis showed also that BKV nephritis is associated with a greater number of rejection episodes and a higher incidence of steroid-resistant rejection requiring antilymphocyte treatment. There was no association between BKV nephropathy and any specific HLA allele. We propose that HLA mismatching promotes the development of BKV nephropathy through rejection-related inflammatory processes and heavy immunosuppression which cause virus reactivation and injury of the tubular epithelium.
authors.affiliation: Departments of Pathology and Biostatistics, University of Pittsburgh, Pittsburgh. awadallay@upmc.edu
authors.forename: Yehia
authors.initials: Y
authors.lastname: Awadalla
authors.forename: Parmjeet
authors.initials: P
authors.lastname: Randhawa
authors.forename: Kris
authors.initials: K
authors.lastname: Ruppert
authors.forename: Adriana
authors.initials: A
authors.lastname: Zeevi
authors.forename: Rene J
authors.initials: RJ
authors.lastname: Duquesnoy
mesh_terms: D000328:Adult; D001739:BK Virus / Q000276:immunology*; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007668:Kidney / Q000276:immunology / Q000821:virology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000276:immunology*; D016559:Tacrolimus / Q000097:blood; D014412:Tumor Virus Infections / Q000276:immunology*
chemical_list: D006680:HLA Antigens; D016559:Tacrolimus