J Korean Med Sci.  2013 Dec;28(12):1711-1715. 10.3346/jkms.2013.28.12.1711.

Impact of Combined Acute Rejection on BK Virus-Associated Nephropathy in Kidney Transplantation

• Kim YJ
• Jeong JC
• Koo TY
• Kwon HY
• Han M
• Jeon HJ
• Ahn C
• Yang J

• KMID: 1779409
• DOI: http://doi.org/10.3346/jkms.2013.28.12.1711

Abstract

BK virus-associated nephropathy (BKVAN) is one of the major causes of allograft dysfunction in kidney transplant (KT) patients. We compared BKVAN combined with acute rejection (BKVAN/AR) with BKVAN alone in KT patients. We retrospectively analyzed biopsy-proven BKVAN in KT patients from 2000 to 2011 at Seoul National University Hospital. Among 414 biopsies from 951 patients, biopsy-proven BKVAN was found in 14 patients. Nine patients had BKVAN alone, while 5 patients had both BKVAN and acute cellular rejection. BKVAN in the BKVAN alone group was detected later than in BKVAN/AR group (21.77 vs 6.39 months after transplantation, P=0.03). Serum creatinine at diagnosis was similar (2.09 vs 2.00 mg/dL). Histological grade was more advanced in the BKVAN/AR group (P=0.034). Serum load of BKV, dose of immunosuppressants, and tacrolimus level showed a higher tendency in the BKVAN alone group; however it was not statistically significant. After anti-rejection therapy, immunosuppression was reduced in the BKVAN/AR group. Renal functional deterioration over 1 yr after BKVAN diagnosis was similar between the two groups (P=0.665). These findings suggest that the prognosis of BKVAN/AR after anti-rejection therapy followed by anti-BKV therapy might be similar to that of BKVAN alone after anti-BKV therapy.

Keyword

Acute Rejection; BK Virus; Kidney Diseases; Kidney Transplantation

MeSH Terms

Acute Disease
Adult
Antiviral Agents/therapeutic use
BK Virus/*physiology
Creatinine/blood
Female
*Graft Rejection/diagnosis/virology
Humans
Immunosuppressive Agents/administration & dosage
Kidney/*virology
Kidney Diseases/pathology/surgery/*virology
*Kidney Transplantation
Male
Middle Aged
Polyomavirus Infections/drug therapy/*etiology/pathology
Retrospective Studies
Tacrolimus/administration & dosage
Time Factors
Transplantation, Homologous/adverse effects
Tumor Virus Infections/drug therapy/*etiology/pathology
Antiviral Agents
Creatinine
Immunosuppressive Agents
Tacrolimus

Figure

• 

  Fig. 1 Courses of renal function and BK viral load in BK virus nephropathy with or without acute rejection. (A) After abrupt reduction of renal function before treatment of BKVAN, renal function was stabilized over 1 yr after BKVAN. There was no significant difference in renal function in 1 yr after diagnosis of BKVAN between BKVAN alone and BKVAN combined with acute rejection. Zero time indicated diagnosis time for BKVAN. Each value was expressed as mean with standard error. P > 0.05 at all time points. (B) BK viral load had decreased after treatment of BKVAN in both groups. Although BK viral loads in the BKV alone group were higher than those in the BKVAN combined with acute rejection group, the differences were not statistically significant (P > 0.05 at all time-points). Zero time indicated diagnosis time for BKVAN. Each value was expressed as mean with standard error. eGFR, estimated glomerular filtration rate. BKVAN, BKVAN alone; BKVAN/AR, BKVAN combined with acute rejection.

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