Unveiling Donor-Derived BKPyV DNAemia Through Analysis of Contralateral Kidney Transplant Recipients

Area of Science:

• Nephrology
• Virology
• Transplant Immunology

Background:

• BK polyomavirus (BKPyV) infection is a significant threat in kidney transplantation, potentially leading to BKPyV-associated nephropathy (BKPyVAN).
• Current treatments for BKPyV infection are lacking, emphasizing the need for preventative measures.
• Emerging evidence suggests donor-derived BKPyV may contribute to BKPyV DNAemia.

Purpose of the Study:

• To investigate the hypothesis that donor-derived BKPyV influences BKPyV DNAemia development.
• To evaluate the risk of BKPyV DNAemia in kidney transplant recipients sharing a donor.

Main Methods:

• Retrospective, multi-center cohort study of deceased donor kidney transplant recipients (2011-2021).
• Identification of recipient pairs receiving kidneys from the same donor.
• Cox regression analysis to assess the association between BKPyV DNAemia in one recipient and the risk in the contralateral recipient.

Main Results:

• BKPyV DNAemia occurred more frequently in recipient pairs where the contralateral recipient was affected (28.8%) compared to unaffected pairs (10.8%, p=0.013).
• Multivariable Cox regression confirmed a significantly increased risk (HR 4.9, 95% CI: 1.8-13.6; p=0.002).

Conclusions:

• Recipients of deceased donor kidneys have a substantially higher risk of BKPyV DNAemia if the contralateral recipient also develops it.
• These findings underscore the critical role of donor-derived factors in BKPyV transmission during kidney transplantation.