Development of BK nephropathy in recipients of simultaneous pancreas-kidney transplantation.
BACKGROUND
BK nephropathy (BKVN) is a significant cause of graft dysfunction in kidney transplant recipients, but its course in simultaneous pancreas-kidney (SPK) recipients is less well studied. The presence of dual organs limits the ability to reduce maintenance immunosuppression, typically the first intervention in the management of BKVN.


METHODS
A single center, retrospective review was conducted of 205 SPK transplants performed from January 1, 2000 to April 30, 2006.


RESULTS
The 5-year actuarial cumulative rate of BKVN was 5.6%. Diagnosis occurred at a median of 20 months after transplant; mean serum creatinine was 2.6, and geometric mean BK serum viral load was 709,274 copies/mL at diagnosis. There was no statistical difference in the cumulative rate according to the use of induction therapy: rabbit antilymphocyte globulin (5-year rate 6.8%, 4/59), alemtuzumab (5-year rate 5.1%, 5/146). Treatment consisted of immunosuppression reduction and half received cidofovir. Eight of nine kidney allografts eventually failed, but all patients retained pancreatic allograft function.


CONCLUSIONS
BKVN occurs in 5.6% of SPK recipients. There is no difference in the cumulative rate of BKVN between patients who received alemtuzumab or rabbit antilymphocyte globulin.
Ison
Michael G
MG
Division of Infectious Disease, Department of Medicine, Feinberg School of Medicine, Northwestern University Chicago, Chicago, IL, USA. mgison@alumni.grinnell.edu
Parker
Michele
M
Stosor
Valentina
V
Kaufman
Dixon B
DB
D000074323:Alemtuzumab; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001739:BK Virus; D003404:Creatinine / Q000097:blood; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality; D027601:Polyomavirus Infections / Q000097:blood / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D011817:Rabbits; D012189:Retrospective Studies; D016019:Survival Analysis; D019562:Viral Load
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D003404:Creatinine