Korean J Transplant.  2023 Nov;37(Suppl 1):S171. 10.4285/ATW2023.F-7583.

Differential effects of desensitization therapy on BK virus viremia after living donor kidney transplantation

• Lee J
• Kim MS
• Huh KH
• Kim SJ
• Lee J

• KMID: 2551791
• DOI: http://doi.org/10.4285/ATW2023.F-7583

Abstract

Background
BK virus (BKV) is a major opportunistic infection in kidney transplant recipients. The clinical effects of desensitization therapy on BKV viremia are unclear.
Methods
We retrospectively analyzed 1,356 adult living-donor kidney transplant recipients between 2006 and 2020 at our hospital. Patients were divided into four groups according to desensitization strategy. A comparison of BKV viremia incidence between groups was performed.
Results
Rituximab group had a 2.2-fold, and rituximab with low-dose intravenous immunoglobulin (IVIG) group had a 1.9-fold higher risk of BKV viremia than control group. Rituximab with high-dose IVIG group had s similar risk of BKV viremia compared to control group. BKV viremia was independently associated with an increased risk of death-censored graft loss in multivariable analysis (hazard ratio, 1.856; 95% confidence interval, 1.094–3.151; P=0.022). Overall patient survival rates were comparable regardless of BKV viremia. Patients with BKV viremia showed inferior graft renal function compared to those without BKV viremia since 2 months prior to BKV viremia diagnosis.
Conclusions
Rituximab increases the risk of BKV viremia, whereas high-dose IVIG reduces the risk of BKV viremia.