title: Evaluating the impact of pre-transplant desensitization utilizing a plasmapheresis and low-dose intravenous immunoglobulin protocol on BK viremia in renal transplant recipients.
abstract: BACKGROUND
  A correlation exists between polyomavirus BK (BKV) viremia in renal transplant recipients (RTR) and the degree of immunosuppression. However, the impact of pre-transplant desensitization on the incidence of BKV viremia is unknown.
  
  
  METHODS
  This retrospective study evaluated living-donor RTR between January 2004 and December 2008 receiving routine BKV viral load monitoring. Patients were divided into those who underwent pre-transplant desensitization (n = 20) and those who did not (n = 71). The primary endpoint was the incidence of BKV viremia at 1 year post transplant.
  
  
  RESULTS
  All demographic data were similar, except for more female patients (65% vs. 36.6%; P = 0.0392) in the desensitized group. More desensitized patients had a previous transplant (75% vs. 12.7%; P < 0.0001) and were more likely to be induced with basiliximab (75% vs. 35.2%; P = 0.0021). Following transplantation, antibody-mediated rejection (AMR) rates were highest in the desensitized group (55% vs. 1.4%; P < 0.0001). The incidence of BKV viremia at 1 year post transplant was significantly higher in desensitized patients (45% vs. 19.7%; P = 0.0385). Desensitization was also associated with a higher prevalence of BKV viremia at any time post transplant (50% vs. 22.5%; P = 0.0245), polyomavirus-associated nephropathy (20% vs. 2.8%; P = 0.0198) and BKV-related allograft loss (10% vs. 0%; P = 0.0464). Also of note, in a subgroup analysis of only our desensitized patients, it did not appear that development of AMR significantly impacted the incidence of BKV viremia in these individuals.
  
  
  CONCLUSIONS
  This analysis reveals that pre-transplant desensitization significantly increases the risk for BKV viremia and nephropathy.
authors: Department of Transplant Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. sgabardi@partners.org
authors: S
authors: S
authors: Gabardi
authors: K
authors: K
authors: Townsend
authors: S T
authors: ST
authors: Martin
authors: A
authors: A
authors: Chandraker
mesh_terms: D000328:Adult; D000368:Aged; D001739:BK Virus / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007165:Immunosuppression Therapy; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000706:statistics & numerical data*; D027601:Polyomavirus Infections / Q000453:epidemiology / Q000821:virology; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000453:epidemiology / Q000821:virology; D014766:Viremia / Q000453:epidemiology* / Q000821:virology
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: BKV viremia; BKV virus; desensitization; polyomavirus; polyomavirus-associated nephropathy; renal transplantation