Korean J Intern Med.  2015 Nov;30(6):865-872. 10.3904/kjim.2015.30.6.865.

Risk factors in the progression of BK virus-associated nephropathy in renal transplant recipients

• Lee HM
• Jang IA
• Lee D
• Kang EJ
• Choi BS
• Park CW
• Choi YJ
• Yang CW
• Kim YS
• Chung BH

• KMID: 2381591
• DOI: http://doi.org/10.3904/kjim.2015.30.6.865

Abstract

BACKGROUND/AIMS
BK virus-associated nephropathy (BKVAN) is an important cause of allograft dysfunction in kidney transplant recipients. It has an unfavorable clinical course, and no definite treatment guidelines have yet been established. Here, we report our center's experience with biopsy-proven BKVAN and investigate factors associated with its progression.
METHODS
From January 2004 to April 2013, 25 patients with BKVAN were diagnosed by biopsy at Seoul St. Mary's Hospital. Of the 25 patients, 10 were deceaseddonor transplant recipients and 15 were living-donor transplant recipients. Three of the patients underwent retransplantation. The primary immunosuppressant used was tacrolimus in 17 patients and cyclosporine in eight patients.
RESULTS
BKVAN was observed at a mean duration of 22.8 ± 29.1 months after transplantation. The mean serum creatinine level at biopsy was 2.2 ± 0.7 mg/dL. BKVAN occurred with acute rejection in eight patients (28%). Immunosuppression modification was performed in 21 patients (84%). Additionally, leflunomide and intravenous immunoglobulin were administered to 13 patients (52%) and two (8%), respectively. Allograft loss occurred in five patients (27.8%) during the follow- up period at 0.7, 17.1, 21.8, 39.8, and 41.5 months after the BKVAN diagnosis. Advanced stages of BKVAN, increased creatinine levels, and accompanying acute rejection at the time of BKVAN diagnosis increased the risk of allograft failure.
CONCLUSIONS
The clinical outcomes in patients with biopsy-proven BKVAN were unfavorable in the present study, especially in patients with advanced-stage BKVAN, poor renal function, and acute allograft rejection.

Keyword

BK virus; Kidney transplantation; Nephropathy

MeSH Terms

Adult
Allografts
Antiviral Agents/therapeutic use
BK Virus/*pathogenicity
Biomarkers/blood
Biopsy
Creatinine/blood
Disease Progression
Female
Graft Rejection/diagnosis/drug therapy/immunology/*virology
Graft Survival
Humans
Immunocompromised Host
Immunosuppressive Agents/adverse effects
Kaplan-Meier Estimate
Kidney Transplantation/*adverse effects
Male
Middle Aged
Opportunistic Infections/diagnosis/drug therapy/immunology/*virology
Polyomavirus Infections/diagnosis/drug therapy/immunology/*virology
Republic of Korea
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Tumor Virus Infections/diagnosis/drug therapy/immunology/*virology
Antiviral Agents
Biomarkers
Creatinine
Immunosuppressive Agents