title: Impact of combined acute rejection on BK virus-associated nephropathy in kidney transplantation.
abstract: BK virus-associated nephropathy (BKVAN) is one of the major causes of allograft dysfunction in kidney transplant (KT) patients. We compared BKVAN combined with acute rejection (BKVAN/AR) with BKVAN alone in KT patients. We retrospectively analyzed biopsy-proven BKVAN in KT patients from 2000 to 2011 at Seoul National University Hospital. Among 414 biopsies from 951 patients, biopsy-proven BKVAN was found in 14 patients. Nine patients had BKVAN alone, while 5 patients had both BKVAN and acute cellular rejection. BKVAN in the BKVAN alone group was detected later than in BKVAN/AR group (21.77 vs 6.39 months after transplantation, P=0.03). Serum creatinine at diagnosis was similar (2.09 vs 2.00 mg/dL). Histological grade was more advanced in the BKVAN/AR group (P=0.034). Serum load of BKV, dose of immunosuppressants, and tacrolimus level showed a higher tendency in the BKVAN alone group; however it was not statistically significant. After anti-rejection therapy, immunosuppression was reduced in the BKVAN/AR group. Renal functional deterioration over 1 yr after BKVAN diagnosis was similar between the two groups (P=0.665). These findings suggest that the prognosis of BKVAN/AR after anti-rejection therapy followed by anti-BKV therapy might be similar to that of BKVAN alone after anti-BKV therapy.
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Yoon Jung
authors: YJ
authors: Kim
authors: Jong Cheol
authors: JC
authors: Jeong
authors: Tai Yeon
authors: TY
authors: Koo
authors: Hyuk Yong
authors: HY
authors: Kwon
authors: Miyeun
authors: M
authors: Han
authors: Hee Jung
authors: HJ
authors: Jeon
authors: Curie
authors: C
authors: Ahn
authors: Jaeseok
authors: J
authors: Yang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus / Q000502:physiology*; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000821:virology*; D007674:Kidney Diseases / Q000473:pathology / Q000601:surgery / Q000821:virology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D014412:Tumor Virus Infections / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus
keywords: Acute Rejection; BK Virus; Kidney Diseases; Kidney Transplantation