Implementing a regional standardized BK polyomavirus screening protocol across eleven transplant centres

Area of Science:

• Nephrology
• Virology
• Transplantation Immunology

Background:

• BK polyomavirus (BKPyV) reactivation is a significant concern post-kidney transplant, potentially leading to BK associated nephropathy (BKAN).
• Effective monitoring protocols are crucial for early detection and management to preserve graft function.

Purpose of the Study:

• To evaluate adherence to a standardized BKPyV screening protocol across multiple transplant centers.
• To assess the incidence of BKPyV infection and BKAN in kidney transplant recipients (KTR).
• To analyze the outcomes of BKPyV infection management, including graft survival and rejection rates.

Main Methods:

• A quality improvement project was conducted by the New England BK Consortium, analyzing data from 1047 KTR across 11 transplant centers (2016-2017).
• BKPyV infection was defined by plasma detection; BKAN was determined by biopsy or clinical diagnosis.
• Treatment primarily involved reduction of immunosuppressants (RIS); outcomes included BKAN progression, graft loss, and acute rejection.

Main Results:

• BKPyV infection was detected in 19% (204/1047) of KTR, with 4% (41/1047) progressing to BKAN.
• Adherence to the screening protocol was suboptimal, at 54% at 12 months and 38% at 24 months.
• No graft loss due to BKAN was observed; however, nine cases of post-RIS acute rejection occurred. Adherence correlated positively with BKPyV detection and BKAN diagnosis.

Conclusions:

• Despite low adherence to screening protocols, BKPyV infection management in this cohort did not result in graft loss.
• Challenges in protocol adherence highlight the complexities of managing KTR.
• Further research is needed to optimize BKPyV surveillance and management strategies to balance infection control and rejection prevention.