Kidney Res Clin Pract.  2018 Jun;37(2):167-173. 10.23876/j.krcp.2018.37.2.167.

Long-term prognosis of BK virus-associated nephropathy in kidney transplant recipients

• Park WY
• Kang SS
• Jin K
• Park SB
• Choe M
• Han S

• KMID: 2416085
• DOI: http://doi.org/10.23876/j.krcp.2018.37.2.167

Abstract

BACKGROUND
The long-term prognosis of BK virus-associated nephropathy (BKVAN) in kidney transplant recipients (KTRs) is uncertain. We evaluated the long-term prognosis in KTRs with BKVAN and the clinical significance of BKVAN on post-transplant clinical outcome.
METHODS
We retrospectively analyzed the medical records of 582 patients who underwent kidney transplant (KT) between 2001 and 2014. We divided the patients into a BKVAN group (15 patients) diagnosed by allograft biopsy and a control group (356 patients).
RESULTS
The incidence of BKVAN was 4.0%, and the mean follow-up duration was 93.1 ± 52.3 months. Median time from KT to BKVAN diagnosis was 5.9 months (interquartile range [IQR], 4.4-8.7). In the BKVAN group, 9 (60.0%) KTRs with combined acute rejection progressed to graft failure, and the median time from BKVAN diagnosis to graft failure was 36.2 months (IQR, 9.7-65.5). Death-censored graft survival rate and patient survival rate in the BKVAN group were significantly lower than those in the control group. BKVAN and rejection were independent risk factors for graft failure. In the subgroup analysis, death-censored graft survival rate of KTRs with BKVAN with acute rejection was significantly worst in comparison with similar patients without BKVAN regardless of acute rejection (P < 0.001).
CONCLUSION
The long-term prognosis of BKVAN with acute rejection was very poor because of graft failure caused by inadequate treatment for acute rejection considering BKVAN. Therefore, we should carefully monitor the allograft status of KTRs through regular surveillance tests after treatment for BKVAN with acute rejection.

Keyword

BK virus; Graft survival; Kidney transplantation; Prognosis; Rejection

MeSH Terms

Allografts
Biopsy
BK Virus
Diagnosis
Follow-Up Studies
Graft Survival
Humans
Incidence
Kidney Transplantation
Kidney*
Medical Records
Prognosis*
Retrospective Studies
Risk Factors
Survival Rate
Transplant Recipients*
Transplants