Britta Höcker1, Lukas Schneble1, Luisa Murer2, Andrea Carraro2, Lars Pape3, Birgitta Kranz4, Jun Oh5, Matthias Zirngibl6, Luca Dello Strologo7, Anja Büscher8, Lutz T Weber9, Atif Awan10, Martin Pohl11, Martin Bald12, Nikoleta Printza13, Krisztina Rusai14, Licia Peruzzi15, Rezan Topaloglu16, Alexander Fichtner1, Kai Krupka1, Lennart Köster1,17, Thomas Bruckner17, Paul Schnitzler18, Hans H Hirsch19,20, Burkhard Tönshoff1. 1. Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany. 2. Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy. 3. Hanover Medical School, Hanover, Germany. 4. Department of General Pediatrics, University Children's Hospital Münster, Münster, Germany. 5. Department of Pediatric Nephrology, University Children's Hospital, Hamburg, Germany. 6. University Children's Hospital, Tübingen, Germany. 7. Pediatric Nephrology and Renal Transplant Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy. 8. Pediatric Nephrology, Pediatrics II, University Children's Hospital Essen, Essen, Germany. 9. Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany. 10. Temple Street Children's University Hospital, Dublin, Ireland. 11. Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. 12. Olga Children's Hospital, Clinic of Stuttgart, Stuttgart, Germany. 13. 1st Pediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece. 14. Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria. 15. Pediatric Nephrology Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Turin, Italy. 16. Hacettepe University Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Turkey. 17. Institute of Medical Biometry and Informatics, University of Heidelberg, Germany. 18. Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany. 19. Transplantation & Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland. 20. Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Abstract
BACKGROUND: BK polyomavirus-associated nephropathy (BKPyVAN) constitutes a serious cause of kidney allograft failure, but large-scale data in pediatric renal transplant recipients and a comprehensive analysis of specific risk factors are lacking. METHODS: We analyzed the data of 313 patients in the Cooperative European Pediatric Renal Transplant Initiative Registry, with an observation period of 3.3 years (range, 1-5). The net state of immunosuppressive therapy was assessed by the modified Vasudev score. RESULTS: Presumptive BKPyVAN (defined as sustained [>3 wk] high-level BK viremia >10 copies/mL) within 5 years posttransplant occurred in 49 (15.8%) of 311 patients, and biopsy-proven BKPyVAN in 14 (4.5%) of 313. BKPyV viremia was observed in 115 (36.7%) of 311 patients, of whom 11 (9.6%) of 115 developed viremia late, that is, after the second year posttransplant. In 6 (12.5%) of 48 patients with high-level viremia and in 3 (21.4%) of 14 with BKPyVAN, this respective event occurred late. According to multivariable analysis, BKPyV viremia and/or BKPyVAN were associated not only with a higher net state of immunosuppression (odds ratio [OR], 1.3; P < 0.01) and with tacrolimus-based versus ciclosporin-based immunosuppression (OR, 3.6; P < 0.01) but also with younger recipient age (OR, 1.1 per y younger; P < 0.001) and obstructive uropathy (OR, 12.4; P < 0.01) as primary renal disease. CONCLUSIONS: Uncontrolled BKPyV replication affects a significant proportion of pediatric renal transplant recipients and is associated with unique features of epidemiology and risk factors, such as young recipient age, obstructive uropathy, and overall intensity of immunosuppressive therapy. BKPyV surveillance should be considered beyond 2 years posttransplant in pediatric patients at higher risk.
BACKGROUND:BK polyomavirus-associated nephropathy (BKPyVAN) constitutes a serious cause of kidney allograft failure, but large-scale data in pediatric renal transplant recipients and a comprehensive analysis of specific risk factors are lacking. METHODS: We analyzed the data of 313 patients in the Cooperative European Pediatric Renal Transplant Initiative Registry, with an observation period of 3.3 years (range, 1-5). The net state of immunosuppressive therapy was assessed by the modified Vasudev score. RESULTS: Presumptive BKPyVAN (defined as sustained [>3 wk] high-level BK viremia >10 copies/mL) within 5 years posttransplant occurred in 49 (15.8%) of 311 patients, and biopsy-proven BKPyVAN in 14 (4.5%) of 313. BKPyV viremia was observed in 115 (36.7%) of 311 patients, of whom 11 (9.6%) of 115 developed viremia late, that is, after the second year posttransplant. In 6 (12.5%) of 48 patients with high-level viremia and in 3 (21.4%) of 14 with BKPyVAN, this respective event occurred late. According to multivariable analysis, BKPyV viremia and/or BKPyVAN were associated not only with a higher net state of immunosuppression (odds ratio [OR], 1.3; P < 0.01) and with tacrolimus-based versus ciclosporin-based immunosuppression (OR, 3.6; P < 0.01) but also with younger recipient age (OR, 1.1 per y younger; P < 0.001) and obstructive uropathy (OR, 12.4; P < 0.01) as primary renal disease. CONCLUSIONS: Uncontrolled BKPyV replication affects a significant proportion of pediatric renal transplant recipients and is associated with unique features of epidemiology and risk factors, such as young recipient age, obstructive uropathy, and overall intensity of immunosuppressive therapy. BKPyV surveillance should be considered beyond 2 years posttransplant in pediatric patients at higher risk.
Authors: Rizky I Sugianto; Bernhard M W Schmidt; Nima Memaran; Ali Duzova; Rezan Topaloglu; Tomas Seeman; Sabine König; Luca Dello Strologo; Luisa Murer; Zeynep Birsin Özçakar; Martin Bald; Mohan Shenoy; Anja Buescher; Peter F Hoyer; Michael Pohl; Heiko Billing; Jun Oh; Hagen Staude; Martin Pohl; Gurkan Genc; Günter Klaus; Caner Alparslan; Ryszard Grenda; Jacek Rubik; Kai Krupka; Burkhard Tönshoff; Elke Wühl; Anette Melk Journal: Pediatr Nephrol Date: 2019-12-07 Impact factor: 3.714
Authors: Christian Patry; Lukas D Sauer; Britta Höcker; Burkhard Tönshoff; Anja Sander; Kai Krupka; Alexander Fichtner; Jolanda Brezinski; Yvonne Geissbühler; Elodie Aubrun; Anna Grinienko; Luca Dello Strologo; Dieter Haffner; Jun Oh; Ryszard Grenda; Lars Pape; Rezan Topaloğlu; Lutz T Weber; Antonia Bouts; Jon Jin Kim; Agnieszka Prytula; Jens König; Mohan Shenoy Journal: Pediatr Nephrol Date: 2022-10-20 Impact factor: 3.651