Isaac E Hall1, Peter Philip Reese2,3,4,5, Sherry G Mansour6,7, Sumit Mohan8,9,10, Yaqi Jia11, Heather R Thiessen-Philbrook11, Daniel C Brennan11, Mona D Doshi12, Thangamani Muthukumar13,14, Enver Akalin15, Meera Nair Harhay16,17,18, Bernd Schröppel19, Pooja Singh20, Francis L Weng21, Jonathan S Bromberg22,23, Chirag R Parikh24. 1. Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah. 2. Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 3. Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 4. Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 5. Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania. 6. Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut. 7. Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut. 8. The Columbia University Renal Epidemiology Group, New York, New York. 9. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York. 10. Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York. 11. Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland. 12. Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan. 13. Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York. 14. Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York. 15. Einstein/Montefiore Abdominal Transplant Program, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York. 16. Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. 17. Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania. 18. Tower Health Transplant Institute, Tower Health System, Philadelphia, Pennsylvania. 19. Section of Nephrology, University Hospital, Ulm, Germany. 20. Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 21. Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey. 22. Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 23. Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland. 24. Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland chirag.parikh@jhmi.edu.
Abstract
BACKGROUND AND OBJECTIVES: BK polyomavirus (BKV) infection commonly complicates kidney transplantation, contributing to morbidity and allograft failure. The virus is often donor-derived and influenced by ischemia-reperfusion processes and disruption of structural allograft integrity. We hypothesized that deceased-donor AKI associates with BKV infection in recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 1025 kidney recipients from 801 deceased donors transplanted between 2010 and 2013, at 13 academic centers. We fitted Cox proportional-hazards models for BKV DNAemia (detectable in recipient blood by clinical PCR testing) within 1 year post-transplantation, adjusting for donor AKI and other donor- and recipient-related factors. We validated findings from this prospective cohort with analyses for graft failure attributed to BKV within the Organ Procurement and Transplantation Network (OPTN) database. RESULTS: The multicenter cohort mean kidney donor profile index was 49±27%, and 26% of donors had AKI. Mean recipient age was 54±13 years, and 25% developed BKV DNAemia. Donor AKI was associated with lower risk for BKV DNAemia (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79). In the OPTN database, 22,537 (25%) patients received donor AKI kidneys, and 272 (0.3%) developed graft failure from BKV. The adjusted hazard ratio for the outcome with donor AKI was 0.7 (95% confidence interval, 0.52 to 0.95). CONCLUSIONS: In a well-characterized, multicenter cohort, contrary to our hypothesis, deceased-donor AKI independently associated with lower risk for BKV DNAemia. Within the OPTN database, donor AKI was also associated with lower risk for graft failure attributed to BKV. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_03_10_CJN18101120_final.mp3.
BACKGROUND AND OBJECTIVES: BK polyomavirus (BKV) infection commonly complicates kidney transplantation, contributing to morbidity and allograft failure. The virus is often donor-derived and influenced by ischemia-reperfusion processes and disruption of structural allograft integrity. We hypothesized that deceased-donor AKI associates with BKV infection in recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 1025 kidney recipients from 801 deceased donors transplanted between 2010 and 2013, at 13 academic centers. We fitted Cox proportional-hazards models for BKV DNAemia (detectable in recipient blood by clinical PCR testing) within 1 year post-transplantation, adjusting for donor AKI and other donor- and recipient-related factors. We validated findings from this prospective cohort with analyses for graft failure attributed to BKV within the Organ Procurement and Transplantation Network (OPTN) database. RESULTS: The multicenter cohort mean kidney donor profile index was 49±27%, and 26% of donors had AKI. Mean recipient age was 54±13 years, and 25% developed BKV DNAemia. Donor AKI was associated with lower risk for BKV DNAemia (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79). In the OPTN database, 22,537 (25%) patients received donor AKI kidneys, and 272 (0.3%) developed graft failure from BKV. The adjusted hazard ratio for the outcome with donor AKI was 0.7 (95% confidence interval, 0.52 to 0.95). CONCLUSIONS: In a well-characterized, multicenter cohort, contrary to our hypothesis, deceased-donor AKI independently associated with lower risk for BKV DNAemia. Within the OPTN database, donor AKI was also associated with lower risk for graft failure attributed to BKV. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_03_10_CJN18101120_final.mp3.
Authors: Jonathan T Wingate; Jared Brandenberger; Andrew Weiss; Lauren G Scovel; Christian S Kuhr Journal: Transpl Infect Dis Date: 2017-01-27 Impact factor: 2.228
Authors: Peter P Reese; Isaac E Hall; Francis L Weng; Bernd Schröppel; Mona D Doshi; Rick D Hasz; Heather Thiessen-Philbrook; Joseph Ficek; Veena Rao; Patrick Murray; Haiqun Lin; Chirag R Parikh Journal: J Am Soc Nephrol Date: 2015-09-15 Impact factor: 10.121
Authors: I E Hall; B Schröppel; M D Doshi; J Ficek; F L Weng; R D Hasz; H Thiessen-Philbrook; P P Reese; C R Parikh Journal: Am J Transplant Date: 2015-03-11 Impact factor: 8.086
Authors: Panduranga S Rao; Douglas E Schaubel; Mary K Guidinger; Kenneth A Andreoni; Robert A Wolfe; Robert M Merion; Friedrich K Port; Randall S Sung Journal: Transplantation Date: 2009-07-27 Impact factor: 4.939
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391