title: Risk Factors for BK Polyoma Virus Treatment and Association of Treatment With Kidney Transplant Failure: Insights From a Paired Kidney Analysis.
abstract: BACKGROUND
  Identification of risk factors for BK polyoma virus (BKPyV) without confounding by donor factors and era effects in paired analysis may inform strategies to prevent BKPyV.
  
  
  METHODS
  In this analysis of 21,575 mate kidney pairs in the Scientific Registry of Transplant Recipients between 2004 and 2010, the presence of a treatment code for BKPyV virus in follow-up forms was used to identify pairs in which 1 of 2 mate kidneys was treated (discordant treatment) or both mate kidneys were treated (concordant treatment).
  
  
  RESULTS
  Among 1975 discordant pairs, younger than 18 years or 60 years or older, male sex, HLA mismatch or 4 greater, acute rejection, and depleting antibody induction had a higher odds of treatment, whereas diabetes and sirolimus had a lower odds of treatment, and treatment was associated with a higher risk of allograft failure (hazards ratio, 2.01; 95% confidence interval, 1.63-2.48). The rate of concordant treatment (0.81%) was 2.8 times higher than expected. Concordant treatment was associated with nonwhite donor ethnicity, donation after circulatory death, transplantation after 2008, and transplantation of mate kidneys in the same center.
  
  
  CONCLUSIONS
  This analysis of kidneys from the same donor in which only 1 transplant was treated for BKPyV identifies specific risk factors (age <18 or ≥ 60 years, male sex, depleting antibody, HLA mismatch ≥ 4) for BKPyV and provides an estimate of the BKPyV-associated risk of allograft failure (hazards ratio = 2.01) without confounding by donor factors or era effects. The higher than expected rate of concordant treatment suggests the importance of donor factors in BKPyV pathogenesis and warrants further study.
authors.affiliation: 1 Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.2 Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada.3 Division of Infectious Disease, University of British Columbia, Vancouver, British Columbia, Canada.4 Tufts-New England Medical Center, Boston, MA.
authors.forename: Sobhana
authors.initials: S
authors.lastname: Thangaraju
authors.forename: Jagbir
authors.initials: J
authors.lastname: Gill
authors.forename: Allissa
authors.initials: A
authors.lastname: Wright
authors.forename: Jianghu
authors.initials: J
authors.lastname: Dong
authors.forename: Caren
authors.initials: C
authors.lastname: Rose
authors.forename: John
authors.initials: J
authors.lastname: Gill
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000627:therapeutic use*; D001739:BK Virus / Q000187:drug effects* / Q000472:pathogenicity; D005260:Female; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology*; D016016:Proportional Hazards Models; D012042:Registries; D020379:Risk Adjustment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014019:Tissue Donors; D017211:Treatment Failure; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D006680:HLA Antigens; D007166:Immunosuppressive Agents