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The risk factors associated with post-transplantation BKPyV nephropathy and BKPyV DNAemia: a prospective study in kidney transplant recipients

Camilla Lorant¹, Justina Zigmantaviciute^2,3, Naima Ali³

¹Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, SE-751 85, Uppsala, Sweden. camilla.lorant@medsci.uu.se.

BMC Infectious Diseases

|February 22, 2024

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View abstract on PubMed

Summary

Male sex and increasing age are risk factors for BKPyV-associated nephropathy (BKPyVAN) after kidney transplantation. BKPyVAN is linked to high viral loads but not specific genotypes.

Area of Science:

Nephrology
Virology
Transplantation Immunology

Background:

BK polyomavirus (BKPyV) infection poses a significant risk for kidney transplant recipients, potentially causing BKPyV-associated nephropathy (BKPyVAN) and graft loss.
Early detection and risk factor identification are crucial for managing BKPyV infection post-transplantation.

Purpose of the Study:

To assess the incidence of BKPyVAN following the implementation of a BKPyV screening program.
To determine the distribution of BKPyV genotypes and subtypes in the Uppsala-Örebro region.
To identify host and viral factors associated with clinically significant BKPyV events.

Main Methods:

A single-center prospective cohort study involving kidney transplant patients (≥18 years) from 2016-2018.
Regular monitoring of BKPyV DNA in plasma and urine, with genotyping and subtyping.

Keywords:

BK Polyomavirus (BKPyV)BKPyV genotype BKPyV risk factors BKPyV-associated nephropathy (BKPyVAN)

Logistic regression analysis to evaluate risk factors like recipient age, sex, and rejection treatment.

Main Results:

Out of 205 patients, 4.9% developed biopsy-confirmed BKPyVAN and 16.1% had high-level BKPyV DNAemia.
Male sex (OR 2.85) and increasing age (OR 1.03 per year) were significant risk factors for BKPyVAN or high-level BKPyV DNAemia.
BKPyVAN correlated with higher viral loads at 3 months post-transplant and transient high-level DNAemia; no genotype-specific differences were observed.

Conclusions:

Male sex and advanced age increase the risk of BKPyVAN or high-level BKPyV DNAemia in kidney transplant recipients.
BKPyVAN is associated with transient, high-level viremia, irrespective of the BKPyV genotype.

Immunosuppression

Kidney transplantation