Nissreen Elfadawy1, Stuart M Flechner, Jesse D Schold, Titte R Srinivas, Emilio Poggio, Richard Fatica, Robin Avery, Sherif B Mossad. 1. Glickman Urological and Kidney Institute,, †Department of Quantitative Health Sciences, and, ‖Department of Infectious Disease in the Medicine Institute, Cleveland Clinic, Cleveland, Ohio;, ‡Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina, §Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland.
Abstract
BACKGROUND AND OBJECTIVES: The objective was to study the long-term impact of transient versus persistent BK viremia on kidney transplant outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 609 recipients who underwent kidney transplant from 2007 to 2011 were screened at months 1-12 for the occurrence of polyomavirus BK viremia; 130 patients (21.7%) developed BK viremia during the first year post-transplant. BK viremia patients were classified according to duration of infection (more or less than 3 months), and BK viral loads (more or less than 10,000 copies/ml) were classified as transient low viremia (n=42), transient high viremia (n=18), persistent low viremia (n=23), and persistent high viremia (n=47). All patients were followed a median of 36 (3-66) months. The rates of BK polyomavirus-associated nephropathy, acute rejection, and 1-year graft function were compared with the polyomavirus BK-negative control group. RESULTS: Patient and graft survival were not significantly different among the groups. Graft function (creatinine; milligrams per deciliter) at 1 year was significantly worse in the persistent high viremia (1.75±0.6) and transient high viremia (1.85±0.7) groups compared with aviremic controls (1.47±0.4; P=0.01 and P=0.01, respectively). The incidence of BK polyomavirus-associated nephropathy was limited to the persistent high viremia group (1.3%, P<0.001). The transient high viremia (50%) and persistent high viremia (34%) groups showed significantly (P=0.01) increased incidence of acute rejection versus aviremic controls (21.5%), transient low viremia (19%), or persistent low viremia (17.3%) groups. CONCLUSION: Low viral load BK viremia, either transient or persistent, was not associated with long-term transplant outcomes. Persistent high viremia was associated with a greater risk for BK polyomavirus-associated nephropathy and subsequent graft dysfunction. Although transient high viremia was not associated with BK polyomavirus-associated nephropathy, it was associated with worse graft function. These data support the role of surveillance for BK viremia after transplant.
BACKGROUND AND OBJECTIVES: The objective was to study the long-term impact of transient versus persistent BK viremia on kidney transplant outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 609 recipients who underwent kidney transplant from 2007 to 2011 were screened at months 1-12 for the occurrence of polyomavirus BK viremia; 130 patients (21.7%) developed BK viremia during the first year post-transplant. BK viremiapatients were classified according to duration of infection (more or less than 3 months), and BK viral loads (more or less than 10,000 copies/ml) were classified as transient low viremia (n=42), transient high viremia (n=18), persistent low viremia (n=23), and persistent high viremia (n=47). All patients were followed a median of 36 (3-66) months. The rates of BK polyomavirus-associated nephropathy, acute rejection, and 1-year graft function were compared with the polyomavirus BK-negative control group. RESULTS:Patient and graft survival were not significantly different among the groups. Graft function (creatinine; milligrams per deciliter) at 1 year was significantly worse in the persistent high viremia (1.75±0.6) and transient high viremia (1.85±0.7) groups compared with aviremic controls (1.47±0.4; P=0.01 and P=0.01, respectively). The incidence of BK polyomavirus-associated nephropathy was limited to the persistent high viremia group (1.3%, P<0.001). The transient high viremia (50%) and persistent high viremia (34%) groups showed significantly (P=0.01) increased incidence of acute rejection versus aviremic controls (21.5%), transient low viremia (19%), or persistent low viremia (17.3%) groups. CONCLUSION: Low viral load BK viremia, either transient or persistent, was not associated with long-term transplant outcomes. Persistent high viremia was associated with a greater risk for BK polyomavirus-associated nephropathy and subsequent graft dysfunction. Although transient high viremia was not associated with BK polyomavirus-associated nephropathy, it was associated with worse graft function. These data support the role of surveillance for BK viremia after transplant.
Authors: Helen Liapis; Gregory A Storch; D Ashley Hill; Jose Rueda; Daniel C Brennan Journal: Nephrol Dial Transplant Date: 2003-02 Impact factor: 5.992
Authors: Nissreen Elfadawy; Stuart M Flechner; Xiaobo Liu; Jesse Schold; Titte R Srinivas; Emilio Poggio; Richard Fatica; Robin Avery; Sherif B Mossad Journal: Transplantation Date: 2013-12-27 Impact factor: 4.939
Authors: V Nickeleit; H H Hirsch; I F Binet; F Gudat; O Prince; P Dalquen; G Thiel; M J Mihatsch Journal: J Am Soc Nephrol Date: 1999-05 Impact factor: 10.121
Authors: M Ahuja; E P Cohen; A M Dayer; B Kampalath; C C Chang; B A Bresnahan; S Hariharan Journal: Transplantation Date: 2001-04-15 Impact factor: 4.939
Authors: Cinthia B Drachenberg; John C Papadimitriou; Hans H Hirsch; Ravinder Wali; Clinton Crowder; Joseph Nogueira; Charles B Cangro; Susan Mendley; Ayesa Mian; Emilio Ramos Journal: Am J Transplant Date: 2004-12 Impact factor: 8.086
Authors: Emilio Ramos; Cinthia B Drachenberg; John C Papadimitriou; Omar Hamze; Jeffrey C Fink; David K Klassen; Rene C Drachenberg; Anne Wiland; Ravinder Wali; Charles B Cangro; Eugene Schweitzer; Stephen T Bartlett; Matthew R Weir Journal: J Am Soc Nephrol Date: 2002-08 Impact factor: 10.121
Authors: Hans H Hirsch; Wendy Knowles; Michael Dickenmann; Jakob Passweg; Thomas Klimkait; Michael J Mihatsch; Jürg Steiger Journal: N Engl J Med Date: 2002-08-15 Impact factor: 91.245
Authors: Benjamin L Laskin; Harsharan K Singh; Ulf H Beier; Taylor Moatz; Susan L Furth; Nancy Bunin; David Witte; Jens Goebel; Stella M Davies; Christopher Dandoy; Sonata Jodele; Volker Nickeleit Journal: Transplantation Date: 2016-10 Impact factor: 4.939
Authors: Isaac E Hall; Peter Philip Reese; Sherry G Mansour; Sumit Mohan; Yaqi Jia; Heather R Thiessen-Philbrook; Daniel C Brennan; Mona D Doshi; Thangamani Muthukumar; Enver Akalin; Meera Nair Harhay; Bernd Schröppel; Pooja Singh; Francis L Weng; Jonathan S Bromberg; Chirag R Parikh Journal: Clin J Am Soc Nephrol Date: 2021-03-10 Impact factor: 8.237
Authors: Darlene Vigil; Nikifor K Konstantinov; Marc Barry; Antonia M Harford; Karen S Servilla; Young Ho Kim; Yijuan Sun; Kavitha Ganta; Antonios H Tzamaloukas Journal: World J Transplant Date: 2016-09-24