title: Ureteral stent placement and immediate graft function are associated with increased risk of BK viremia in the first year after kidney transplantation.
abstract: Ureteral stent (UrSt) placement has been shown to be a significant independent risk factor for BK viruria, viremia, and BK virus nephropathy. We assessed whether this observation could be validated at our high volume kidney transplant center that has had a strong historical focus on BK virus nephropathy detection. We performed a retrospective case-control study of adults receiving a kidney-only transplant and followed for 1 year between 2004 and 2011 with uniform immunosuppression and use of blood BK virus PCR screening protocol. Among 1147 patients, 443 (38.6%) received a UrSt and 17.2% with a UrSt had BK viremia versus 13.5% without stent (odds ratio 1.33; 95% CI: 1.00-1.78). We confirmed a previously reported association between immediate graft function (IGF) and higher rate of BK viremia (15.7% vs. 5.9% in patients without IGF). On multivariable competing risks Cox regression in patients with IGF, UrSt (adjusted hazard ratio [aHR] 1.35; 95% CI: 1.04-1.75) and African American race (aHR 1.47; 95% CI: 1.04-2.09) significantly increased the risk for BK viremia. In the largest sample size to date, we confirmed that UrSt placement during kidney transplant surgery is a risk factor for BK viremia within the first year post-transplant and that IGF is associated with BK viremia.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Joseph G
authors.identifier: http://orcid.org/0000-0003-4672-1164
authors.initials: JG
authors.lastname: Maliakkal
authors.affiliation: Division of Nephrology, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.affiliation: Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Goss
authors.affiliation: Division of Nephrology, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Horwedel
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Chen
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Dennis K
authors.initials: DK
authors.lastname: Fong
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Schechtman
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Vikas R
authors.identifier: http://orcid.org/0000-0001-8000-1385
authors.initials: VR
authors.lastname: Dharnidharka
mesh_terms: D001739:BK Virus; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D014546:Urinary Catheterization / Q000009:adverse effects*; D014766:Viremia / Q000209:etiology*
keywords: BK virus; Infection; Polyoma; complications; kidney clinical; kidney transplant; outcome; surgery ureteral stent