Wisit Cheungpasitporn1, Walter K Kremers2, Elizabeth Lorenz1,3, Hatem Amer1,3, Fernando G Cosio1,3, Mark D Stegall3,4, Manish J Gandhi5, Carrie A Schinstock1,3. 1. Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. 2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. 3. The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA. 4. Division of Transplantation Surgery, Department of Medicine, Mayo Clinic, Rochester, MN, USA. 5. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Abstract
BACKGROUND AND OBJECTIVES: The risk of de novo donor-specific antibody (dnDSA) development following BK viremia (BKV) or nephropathy (BKN) after kidney transplant remains unclear. We aimed to evaluate the relationships among dnDSA, BKV (BK blood PCR > 15 000 copies), BKN, antibody-mediated rejection (AMR), and allograft loss. PATIENTS AND METHODS: We performed a retrospective cohort study of 904 solitary kidney transplant recipients transplanted between 10/2007 and 5/2014. Cox proportional hazards regression with time-dependent covariates were used to assess the relationships among BKN, isolated BKV, dnDSA, and the subsequent risk of AMR and allograft loss. RESULTS: In multivariate analysis, we observed that BKN, but not BKV was a risk factor for dnDSA (HR, 3.18, P = .008). Of the patients with BK nephropathy, 14.0% (6/43) developed dnDSA, which occurred within 14 months of BK diagnosis. DnDSA in this setting remains a risk factor for subsequent AMR (HR 4.75, P = .0001) and allograft loss (HR 2.63, P = .018). CONCLUSIONS: BKN is an independent risk factor for development of dnDSA. Improved understanding of the characteristics of patients with BKN who are at highest risk for development of dnDSA would be valuable to customize immunosuppression reduction in this population.
BACKGROUND AND OBJECTIVES: The risk of de novo donor-specific antibody (dnDSA) development following BK viremia (BKV) or nephropathy (BKN) after kidney transplant remains unclear. We aimed to evaluate the relationships among dnDSA, BKV (BK blood PCR > 15 000 copies), BKN, antibody-mediated rejection (AMR), and allograft loss. PATIENTS AND METHODS: We performed a retrospective cohort study of 904 solitary kidney transplant recipients transplanted between 10/2007 and 5/2014. Cox proportional hazards regression with time-dependent covariates were used to assess the relationships among BKN, isolated BKV, dnDSA, and the subsequent risk of AMR and allograft loss. RESULTS: In multivariate analysis, we observed that BKN, but not BKV was a risk factor for dnDSA (HR, 3.18, P = .008). Of the patients with BKnephropathy, 14.0% (6/43) developed dnDSA, which occurred within 14 months of BK diagnosis. DnDSA in this setting remains a risk factor for subsequent AMR (HR 4.75, P = .0001) and allograft loss (HR 2.63, P = .018). CONCLUSIONS:BKN is an independent risk factor for development of dnDSA. Improved understanding of the characteristics of patients with BKN who are at highest risk for development of dnDSA would be valuable to customize immunosuppression reduction in this population.
Authors: Carrie A Schinstock; Darshana M Dadhania; Matthew J Everly; Byron Smith; Manish Gandhi; Evan Farkash; Vijay K Sharma; Milagros Samaniego-Picota; Mark D Stegall Journal: Transpl Int Date: 2019-02-08 Impact factor: 3.782
Authors: Wisit Cheungpasitporn; Charat Thongprayoon; Pradeep K Vaitla; Api Chewcharat; Panupong Hansrivijit; Felicitas L Koller; Michael A Mao; Tarun Bathini; Sohail Abdul Salim; Sreelatha Katari; Lee S Cummings; Eddie Island; Jameson Forster; Napat Leeaphorn Journal: J Clin Med Date: 2020-05-14 Impact factor: 4.241
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