title: Symptomatic BK Virus Infection Is Associated With Kidney Function Decline and Poor Overall Survival in Allogeneic Hematopoietic Stem Cell Recipients.
abstract: Nephropathy due to BK virus (BKV) infection is an evolving challenge in patients undergoing hematopoietic stem cell transplantation (HSCT). We hypothesized that BKV infection was a marker of kidney function decline and a poor prognostic factor in HSCT recipients who experience this complication. In this retrospective study, we analyzed all patients who underwent their first allogeneic HSCT at our institution between 2004 and 2012. We evaluated the incidence of persistent kidney function decline, which was defined as a confirmed reduction in estimated glomerular filtration rate of at least 25% from baseline using the Chronic Kidney Disease Epidemiology equation. Cox proportional hazard regression was used to model the cause-specific hazard of kidney function decline, and the Fine-Gray method was used to account for the competing risks of death. Among 2477 recipients of a first allogeneic HSCT, BK viruria was detected in 25% (n = 629) and kidney function decline in 944 (38.1%). On multivariate analysis, after adjusting for age, sex, acute graft-versus-host disease (GVHD), chronic GVHD, preparative conditioning regimen, and graft source, BK viruria remained a significant risk factor for kidney function decline (p < 0.001). In addition, patients with BKV infection and kidney function decline experienced worse overall survival. After allogeneic HSCT, BKV infection was strongly and independently associated with subsequent kidney function decline and worse patient survival after HSCT.
authors.affiliation: Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: A
authors.initials: A
authors.lastname: Abudayyeh
authors.affiliation: Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: A
authors.initials: A
authors.lastname: Hamdi
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: H
authors.initials: H
authors.lastname: Lin
authors.affiliation: Division of Medical Oncology, Duke University School of Medicine, Durham, NC.
authors.forename: M
authors.initials: M
authors.lastname: Abdelrahim
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: G
authors.initials: G
authors.lastname: Rondon
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: B S
authors.initials: BS
authors.lastname: Andersson
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: A
authors.initials: A
authors.lastname: Afrough
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: C S
authors.initials: CS
authors.lastname: Martinez
authors.affiliation: Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: J J
authors.initials: JJ
authors.lastname: Tarrand
authors.affiliation: Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: D P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: D
authors.initials: D
authors.lastname: Marin
authors.affiliation: Department of Transplant Surgery, Houston Methodist Hospital, Houston, TX.
authors.forename: A O
authors.initials: AO
authors.lastname: Gaber
authors.affiliation: Department of Nephrology, Southern Arizona VA Healthcare System, Tuscon, AZ.
authors.forename: A
authors.initials: A
authors.lastname: Salahudeen
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: B
authors.initials: B
authors.lastname: Oran
authors.affiliation: Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: R F
authors.initials: RF
authors.lastname: Chemaly
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: A
authors.initials: A
authors.lastname: Olson
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: R
authors.initials: R
authors.lastname: Jones
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: U
authors.initials: U
authors.lastname: Popat
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: R E
authors.initials: RE
authors.lastname: Champlin
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: E J
authors.initials: EJ
authors.lastname: Shpall
authors.affiliation: Section of Nephrology, Baylor College of Medicine, Houston, TX.
authors.forename: W C
authors.identifier: 0000-0002-5272-425X
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: K
authors.initials: K
authors.lastname: Rezvani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001739:BK Virus / Q000472:pathogenicity*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality*; D006402:Hematologic Diseases / Q000150:complications / Q000401:mortality* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000401:mortality* / Q000821:virology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000401:mortality* / Q000821:virology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000401:mortality* / Q000821:virology; D055815:Young Adult