1. Association of BKV viremia and nephropathy with adverse alloimmune outcomes in kidney transplant recipients.
- Author
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Rampersad C, Wiebe C, Balshaw R, Bullard J, Gibson IW, Trachtenberg A, Shaw J, Villalobos APC, Karpinski M, Goldberg A, Birk P, Pinsk M, Rush DN, Nickerson PW, and Ho J
- Subjects
- Humans, Female, Male, Middle Aged, Follow-Up Studies, Prognosis, Risk Factors, Glomerular Filtration Rate, Adult, Postoperative Complications, Immunosuppressive Agents therapeutic use, Immunosuppressive Agents adverse effects, Retrospective Studies, Kidney Failure, Chronic surgery, Kidney Failure, Chronic immunology, Kidney Diseases virology, Kidney Diseases immunology, Kidney Diseases surgery, Transplant Recipients, Kidney Transplantation adverse effects, BK Virus immunology, BK Virus isolation & purification, Polyomavirus Infections immunology, Polyomavirus Infections virology, Polyomavirus Infections complications, Graft Survival, Graft Rejection etiology, Graft Rejection immunology, Tumor Virus Infections immunology, Tumor Virus Infections virology, Viremia immunology, Viremia virology, Kidney Function Tests
- Abstract
Background: Immunosuppression reduction for BK polyoma virus (BKV) must be balanced against risk of adverse alloimmune outcomes. We sought to characterize risk of alloimmune events after BKV within context of HLA-DR/DQ molecular mismatch (mMM) risk score., Methods: This single-center study evaluated 460 kidney transplant patients on tacrolimus-mycophenolate-prednisone from 2010-2021. BKV status was classified at 6-months post-transplant as "BKV" or "no BKV" in landmark analysis. Primary outcome was T-cell mediated rejection (TCMR). Secondary outcomes included all-cause graft failure (ACGF), death-censored graft failure (DCGF), de novo donor specific antibody (dnDSA), and antibody-mediated rejection (ABMR). Predictors of outcomes were assessed in Cox proportional hazards models including BKV status and alloimmune risk defined by recipient age and molecular mismatch (RAMM) groups., Results: At 6-months post-transplant, 72 patients had BKV and 388 had no BKV. TCMR occurred in 86 recipients, including 27.8% with BKV and 17% with no BKV (p = .05). TCMR risk was increased in recipients with BKV (HR 1.90, (95% CI 1.14, 3.17); p = .01) and high vs. low-risk RAMM group risk (HR 2.26 (95% CI 1.02, 4.98); p = .02) in multivariable analyses; but not HLA serological MM in sensitivity analysis. Recipients with BKV experienced increased dnDSA in univariable analysis, and there was no association with ABMR, DCGF, or ACGF., Conclusions: Recipients with BKV had increased risk of TCMR independent of induction immunosuppression and conventional alloimmune risk measures. Recipients with high-risk RAMM experienced increased TCMR risk. Future studies on optimizing immunosuppression for BKV should explore nuanced risk stratification and may consider novel measures of alloimmune risk., (© 2024 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.)
- Published
- 2024
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