ArticleAmerican journal of nephrology2025
Retrospective Analysis of Graft Loss Risk in Patients with BK Polyomavirus Associated Nephropathy in Relation to Rejection Status in a Multicentre Cohort with Regular Surveillance of BK Polyomavirus and Donor-Specific Antibody.
Article in American journal of nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionBK polyomavirus (BKPyV) in kidney transplant associated with adverse graft outcome. The aim of this study was to examine graft loss risk of BKPyV associated nephropathy (BKPyVAN) and BKPyV-DNAemia in relation with de novo donor-specific antibody (DSA) and rejection status.
methodsTwo hundred and forty patients from a multicentre cohort who had regular BKPyV and donor-DSA surveillance were retrospectively reviewed and stratified according to the presence of BKPyV-DNAemia and rejection.
resultsBKPyV-DNAemia did not associate with de novo DSA development (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.50-2.67, p = 0.74) but de novo DSA was more commonly observed in patients who developed rejection (BKV+/rejection- 4.3% (n = 2) vs. BKV+/rejection+ 57.1% (n = 4), p < 0.001). BKPyV-DNAemia (adjusted HR 4.02, 95% CI: 1.30-12.43, p = 0.016) and de novo DSA (adjusted HR 6.76, 95% CI: 2.51-18.24, p < 0.001) were independent factors associated with antibody-mediated rejection. Patients with BKPyV-DNAemia who were further complicated with rejection had approximately 6-fold risk of graft loss (adjusted HR 6.24, 95% CI: 2.04-19.09, p = 0.001), whereas patient with BKPyV-DNAemia alone did not experience significant increase graft loss risk (adjusted HR 1.76, 95% CI: 0.64-4.81, p = 0.27).
conclusionsOur study suggested that DSA monitoring would be warranted during immunosuppressant reduction for BKPyV-DNAemia and less aggressive reduction of immunosuppressant when DSA emerges might be a reasonable strategy to avoid overzealous reduction of immunosuppressant that could precipitate allograft rejection.
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