1547. BK Virus Reactivation in Solitary Heart Transplant Recipients: Prevalence and Relationship to Kidney Dysfunction

Abstract

BackgroundPolyomavirus-associated nephropathy has been reported in nonrenal solid-organ transplant in recent years, including seven cases in heart transplant (HT) recipients. Of these, two are from our institution. We sought to better understand the prevalence of BK virus (BKV) in our HT population on contemporary immunosuppression, identify potential predictors of BKV reactivation, and explore its relationship to glomerular filtration rate (GFR) following HT.MethodsWe performed a cross-sectional analysis of 101 adult HT recipients who presented to care between 3 months and 5 years post-transplant. Dual heart-kidney transplant and dialysis-dependent patients were excluded. Consented patients submitted simultaneous urine sample for BKV PCR and serum sample for BKV PCR, creatinine, glucose and lymphocyte count. Variables collected from the electronic medical record included demographics, time since transplant, immunosuppression, comorbidities, rejection, and cytomegalovirus (CMV) infection.ResultsOf 96 patients included in the study, 29 (30%) had viruria. Eleven of 96 (12%) were viremic (including two who were viremic without viruria). The majority of viremic patients (64%) were between 3 and 12 months post-transplant. Three viremic patients had greater than 10,000 copies of virus detectable in serum. Compared with negative patients, viremic patients tended to be male (73%), White (100%), older than age 55 (73%), to have ischemic heart disease (45.5%), to be on prednisone (73%), and to have a slightly higher mean serum glucose (154 mg/dL), although none of these differences were statistically significant. Nearly, all participants were on tacrolimus and 88% of the total cohort was on mycophenolate. There were no significant differences in number of rejection episodes, treatment with anti-thymocyte globulin, CMV infection, lymphopenia, GFR, or decline in GFR since transplant.ConclusionWe observed higher rates of BKV replication in both urine and serum than previously reported. There was no difference in GFR at the time of random screening and no clear predictors of viremia. Longitudinal studies are needed to assess the effect of BK viremia in HT recipients.Disclosures All authors: No reported disclosures.