High-dose steroid therapy in BK viremia adversely affected the long-term graft function after kidney transplantation.
BACKGROUND
Although high-dose steroid therapy has been attempted for the management of clinically suspected allograft rejection, before testing for BK viral activity or acute cellular rejection accompanied by BK polyomavirus nephropathy, its long-term outcome remains unknown. We investigated the impact of high-dose steroids on BK viral activity and long-term graft outcomes in patients with BK viremia.


METHODS
The study population comprised 144 kidney transplant recipients with BK viremia. They were divided into 2 groups based on the amount of steroids administered: low-dose group (<2 g, n=123) or high-dose group (≥2 g, n=21).


RESULTS
The baseline serum BK viral loads were 5.4±1.1 log cp/mL in the low-dose group and 6.0±1.3 in the high-dose group (P=.054). These changed to 5.2±1.3 and 6.1±1.4, 1 month after steroid treatment (P=.03) and 4.9±1.3 and 5.9±1.4 at 2 months (P=.033), respectively. From 3 months to 1 year, the serum BK viral titers were not different between groups. Kaplan-Meier analyses demonstrated that the rates of the decline of graft function and graft failure were higher in the high-dose group (P=.02 and P=.04, respectively). High-dose steroids (P=.012, hazard ratio [HR] 5.04, 95% confidence interval [CI] 1.42-17.85) and log serum BK viral load at 2 months after steroid treatment (P=.042, HR 1.52, 95% CI 1.02-2.28) were independent risk factors for the decline of graft function.


CONCLUSIONS
High-dose steroids induced BK viral activation and subsequently resulted in poor long-term graft function and early graft failure in patients with BK viremia.
Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hyosang
H
Kim
Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hoon
H
Yu
Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Chung Hee
CH
Baek
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Duck Jong
DJ
Han
Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Su-Kil
SK
Park
D000328:Adult; D000368:Aged; D001739:BK Virus / Q000302:isolation & purification / Q000502:physiology*; D001706:Biopsy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000097:blood / Q000139:chemically induced* / Q000821:virology; D020551:Pulse Therapy, Drug / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D014412:Tumor Virus Infections / Q000188:drug therapy* / Q000821:virology; D019562:Viral Load / Q000187:drug effects*; D014766:Viremia / Q000097:blood / Q000139:chemically induced* / Q000821:virology; D014775:Virus Activation / Q000187:drug effects*
D005938:Glucocorticoids
BK virus; kidney transplantation; steroids