title: Simultaneous pancreas/kidney transplant recipients present with late-onset BK polyomavirus-associated nephropathy.
abstract: Infections have increased in simultaneous pancreas/kidney transplant recipients (SPKTRs) with BK polyomavirus (BKV)-associated nephropathy (BKVN) being the most important infectious cause of allograft loss. Comparisons of BKVN with kidney transplant recipients (KTRs), however, are lacking.
  
  
  
  We studied all SPKTRs and KTRs at our transplant centre between 2003 and 2012. Eleven of 106 SPKTs (10.4%) and 21 of 1062 KTRs (2.0%) were diagnosed with BKVN with allograft loss in 1 SPKTR (9.1%) and 2 KTRs (9.5%). A control of 95 SPKTRs without BKVN was used for comparison.
  
  
  
  SPKTRs showed an increased incidence of BKVN compared with KTRs (P < 0.001). Onset of BKVN in SPKTRs was significantly later compared with KTRs (P = 0.033). While 67% of KTRs showed early-onset BKVN, 64% of SPKTRs developed late-onset BKVN. Older recipient age and male gender increased the risk of BKVN in SPKTRs (P < 0.05). No differences were observed for patient and allograft survival (P > 0.05). However, SPKTRs with BKVN showed inferior estimated glomerular filtration rate and a higher incidence of de novo donor-specific antibodies compared with SPKTRs without BKVN in long-term follow-up (P < 0.05). SPKTRs showed higher peak BKV loads, a need for more intense therapeutic intervention and were more likely not to recover to baseline creatinine after BKVN (P < 0.05).
  
  
  
  Our results suggest a higher incidence, more severe course and inferior outcome of BKVN in SPKTRs. An increased vulnerability of the allograft kidney due to inferior organ quality may predispose KTRs to early-onset BKVN. In contrast, SPKTRs present with late-onset BKVN in the presence of high-dose immunosuppression.
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, 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, Campus Virchow Clinic, Berlin, Germany.
authors.forename: Marina
authors.initials: M
authors.lastname: Zaks
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kahl
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Reinke
mesh_terms: D000328:Adult; D001739:BK Virus; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control / Q000821:virology*; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000276:immunology / Q000401:mortality / Q000601:surgery / Q000821:virology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D027601:Polyomavirus Infections / Q000276:immunology / Q000401:mortality / Q000821:virology*; D016016:Proportional Hazards Models; D066027:Transplant Recipients; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000276:immunology / Q000401:mortality / Q000821:virology*
chemical_list: D007166:Immunosuppressive Agents
keywords: BKV-associated nephropathy; donor-specific antibodies; kidney transplantation; simultaneous pancreas/kidney transplantation