title: Pretransplantation Donor-Recipient Pair Seroreactivity Against BK Polyomavirus Predicts Viremia and Nephropathy After Kidney Transplantation.
abstract: Kidney transplant donors are not currently implicated in predicting BK polyomavirus (BKPyV) infection in kidney transplant recipients. It has been postulated, however, that BKPyV infection originates from the kidney allograft. Because BKPyV seroreactivity correlates with BKPyV replication and thus might mirror the infectious load, we investigated whether BKPyV seroreactivity of the donor predicts viremia and BKPyV-associated nephropathy (BKPyVAN) in the recipient. In a retrospective cohort of 407 living kidney donor-recipient pairs, pretransplantation donor and recipient sera were tested for BKPyV IgG levels and correlated with the occurrence of recipient BKPyV viremia and BKPyVAN within 1 year after transplantation. Donor BKPyV IgG level was strongly associated with BKPyV viremia and BKPyVAN (p < 0.001), whereas recipient BKPyV seroreactivity showed a nonsignificant inverse trend. Pairing of high-BKPyV-seroreactive donors with low-seroreactive recipients resulted in a 10-fold increased risk of BKPyV viremia (hazard ratio 10.1, 95% CI 3.5-29.0, p < 0.001). In multivariate analysis, donor BKPyV seroreactivity was the strongest pretransplantation factor associated with viremia (p < 0.001) and BKPyVAN (p = 0.007). The proportional relationship between donor BKPyV seroreactivity and recipient infection suggests that donor BKPyV seroreactivity reflects the infectious load of the kidney allograft and calls for the use of pretransplantation BKPyV serological testing of (potential) donors and recipients.
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: H F
authors.identifier: 0000-0001-9491-0790
authors.initials: HF
authors.lastname: Wunderink
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: van der Meijden
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: C S
authors.initials: CS
authors.lastname: van der Blij-de Brouwer
authors.affiliation: Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: M J K
authors.initials: MJ
authors.lastname: Mallat
authors.affiliation: Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: G W
authors.initials: GW
authors.lastname: Haasnoot
authors.affiliation: Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: van Zwet
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: E C J
authors.initials: EC
authors.lastname: Claas
authors.affiliation: Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: de Fijter
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: A C M
authors.initials: AC
authors.lastname: Kroes
authors.affiliation: UMR INRA 1282 ISP Université François Rabelais, Tours, France.
authors.forename: F
authors.initials: F
authors.lastname: Arnold
authors.affiliation: UMR INRA 1282 ISP Université François Rabelais, Tours, France.
authors.forename: A
authors.initials: A
authors.lastname: Touzé
authors.affiliation: Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: F H J
authors.initials: FH
authors.lastname: Claas
authors.affiliation: Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: J I
authors.initials: JI
authors.lastname: Rotmans
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: M C W
authors.initials: MC
authors.lastname: Feltkamp
mesh_terms: D001739:BK Virus / Q000472:pathogenicity*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D027601:Polyomavirus Infections / Q000097:blood / Q000276:immunology* / Q000821:virology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D014412:Tumor Virus Infections / Q000097:blood / Q000276:immunology* / Q000821:virology; D014766:Viremia / Q000175:diagnosis* / Q000209:etiology
keywords: BK polyomavirus; basic (laboratory) research/science; clinical research/practice; donors and donation: donor-derived infections; infection and infectious agents; infectious disease; kidney disease: infectious; kidney transplantation; kidney transplantation/nephrology; nephropathy; risk assessment/risk stratification; risk factors; serology; seroreactivity; viral: BK/JC/polyoma; viremia