title: Different risk factor profiles distinguish early-onset from late-onset BKV-replication.
abstract: Two of three reactivations of latent BKV-infection occur within the first 6 months after renal transplantation. However, a clear differentiation between early-onset and late-onset BKV-replication is lacking. Here, we studied all kidney transplant recipients (KTRs) at our single transplant center between 2004 and 2012. A total of 103 of 862 KTRs were diagnosed with BK viremia (11.9%), among which 24 KTRs (2.8%) showed progression to BKV-associated nephropathy (BKVN). Sixty-seven KTRs with early-onset BKV-replication (65%) and 36 KTRs with late-onset BKV-replication (35%) were identified. A control group of 598 KTRs without BKV-replication was used for comparison. Lymphocyte-depleting induction, CMV-reactivation, and acute rejection increased the risk of early-onset BKV-replication (P < 0.05). Presensitized KTRs undergoing renal retransplantation were those at increased risk of late-onset BKV-replication (P < 0.05). Among KTRs with BK viremia, higher doses of mycophenolate increased the risk of progression to BKVN (P = 0.004). KTRs with progression to BKVN showed inferior allograft function (P < 0.05). KTRs with late-onset BK viremia were more likely not to recover to baseline creatinine after BKV-replication (P = 0.018). Our data suggest different risk factors in the pathogenesis of early-onset and late-onset BKV-reactivation. While a more intensified immunosuppression is associated with early-onset BKV-replication, a chronic inflammatory state in presensitized KTRs may contribute to late-onset BKV-replication.
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany.|Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachtner
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany.|Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Babel
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany.|Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Reinke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001739:BK Virus; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D027601:Polyomavirus Infections / Q000209:etiology; D051437:Renal Insufficiency / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014779:Virus Replication; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine
keywords: BK polyomavirus; CMV; renal transplantation