title: Persistent BK viremia does not increase intermediate-term graft loss but is associated with de novo donor-specific antibodies.
abstract: There are limited data regarding intermediate-term outcomes in patients with persistent BK viremia. Other viral infections have been implicated in the development of allosensitization through heterologous immunity, but the relationship between BK viremia and donor-specific antibodies (DSAs) is unexplored. In 2008, we initiated routine post-transplant BK viremia and DSA screening at our center; 785 kidney or kidney-pancreas transplant recipients were included in our study. Of these recipients, 132 (17%) recipients developed BK viremia during the study period. The median duration of BK viremia was 140 days (interquartile range=40-393 days), and persistent BK viremia was defined as lasting ≥140 days. Kaplan-Meier curves were generated to assess differences in patient and allograft survival on the basis of BK viremia status; survival was modeled using Cox proportional hazard regression. After a median follow-up of 3 years, there was no significant difference in terms of patient (hazard ratio [HR], 0.83; 95% confidence interval [95% CI], 0.28 to 2.49) or allograft survival (HR, 0.80; 95% CI, 0.37 to 1.73) between patients with and without BK viremia, which was confirmed in a time-varying analysis. In our logistic regression model, persistent BK viremia was strongly associated with the development of class II (HR, 2.55; 95% CI, 1.30 to 4.98) but not class I (HR, 1.13; 95% CI, 0.46 to 2.77) DSAs. These data suggest that persistent BK viremia does not negatively affect intermediate-term patient or allograft survival but is associated with increased risk for de novo DSA, although the exact mechanism is unclear.
authors.affiliation: Department of Medicine, Renal Electrolyte and Hypertension Division, deirdre.sawinski@uphs.upenn.edu.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Sawinski
authors.affiliation: Department of Medicine, Gastroenterology Division, and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Forde
authors.affiliation: Department of Medicine, Renal Electrolyte and Hypertension Division, Department of Pharmacy Services, Hospital of the University of Pennsylvania Philadelphia, Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Trofe-Clark
authors.affiliation: Department of Medicine, Renal Electrolyte and Hypertension Division.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Medicine, Renal Electrolyte and Hypertension Division.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Olivera
authors.affiliation: Department of Medicine, Renal Electrolyte and Hypertension Division.
authors.forename: Simin
authors.initials: S
authors.lastname: Goral
authors.affiliation: Department of Medicine, Renal Electrolyte and Hypertension Division.
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood; D001739:BK Virus; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D027601:Polyomavirus Infections / Q000453:epidemiology / Q000276:immunology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology*; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D014766:Viremia / Q000453:epidemiology / Q000276:immunology*
chemical_list: D000906:Antibodies
keywords: kidney transplantation; risk factors; transplant outcomes