title: Factors Influencing Graft Outcomes Following Diagnosis of Polyomavirus -Associated Nephropathy after Renal Transplantation.
abstract: BACKGROUND
  Polyomavirus associated nephropathy (PVAN) is a significant cause of early allograft loss and the course is difficult to predict. The aim of this study is to identify factors influencing outcome for PVAN.
  
  
  METHODS
  Between 2006 and 2014, we diagnosed PVAN in 48 (7.8%) of 615 patients monitored for BK virus every 1-4 weeks after modification of maintenance immunosuppression. Logistic or Cox regression analysis were performed to determine which risk factors independently affected clinical outcome and graft loss respectively.
  
  
  RESULTS
  After 32.1±26.4 months follow-up, the frequencies of any graft functional decline at 1 year post-diagnosis, graft loss and any graft functional decline at the last available follow-up were 27.1% (13/48), 25.0% (12/48), and 33.3% (16/48), respectively. The 1, 3, 5 year graft survival rates were 100%, 80.5% and 69.1%, respectively. The mean level of serum creatinine at 1 year post-diagnosis and long-term graft survival rates were the worst in class C (p<0.05). Thirty-eight of 46 (82.6%) BKV DNAuria patients reduced viral load by 90% with a median time of 2.75 months (range, 0.25-34.0 months) and showed better graft survival rates than the 8 patients (17.4%) without viral load reduction (p<0.001). Multivariate logistic regression analysis showed that extensive interstitial inflammation (OR 20.2, p = 0.042) and delayed fall in urinary viral load (>2.75 months for >90% decrease) in urine (OR 16.7, p = 0.055) correlated with worse creatinine at 1 year post-diagnosis. Multivariate Cox regression analysis showed that extensive interstitial inflammation (HR 46988, p = 0.032) at diagnosis, and high PVAN stage (HR 162.2, p = 0.021) were associated with worse long-term graft survival rates.
  
  
  CONCLUSIONS
  The extent of interstitial inflammation influences short and long-term graft outcomes in patients with PVAN. The degree of PVAN, rate of reduction in viral load, and viral clearance also can be used as prognostic markers in PVAN.
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Huang
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Lin-wei
authors.initials: LW
authors.lastname: Wu
authors.affiliation: Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Shi-Cong
authors.initials: SC
authors.lastname: Yang
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Ji-guang
authors.initials: JG
authors.lastname: Fei
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Su-xiong
authors.initials: SX
authors.lastname: Deng
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Guo-dong
authors.initials: GD
authors.lastname: Chen
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Fu
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Rong-hai
authors.initials: RH
authors.lastname: Deng
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Qiu
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Chang-xi
authors.initials: CX
authors.lastname: Wang
authors.affiliation: Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Li-zhong
authors.initials: LZ
authors.lastname: Chen
mesh_terms: D000328:Adult; D001739:BK Virus / Q000235:genetics / Q000502:physiology*; D004279:DNA, Viral / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007674:Kidney Diseases / Q000175:diagnosis / Q000276:immunology / Q000821:virology*; D016030:Kidney Transplantation; D008297:Male; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000276:immunology; D011379:Prognosis; D012307:Risk Factors; D019562:Viral Load
chemical_list: D004279:DNA, Viral