BK polyomavirus infection after renal transplantation: Surveillance in a resource-challenged setting.

Abstract

There is a paucity of data available about BK polyomavirus (BKPyV) infection after renal transplantation (RTX) in resource-limited countries with a predominantly living-donor, ABO-compatible RTX program. We aimed to assess BKPyV infection in such patients in a public hospital in India. We prospectively evaluated plasma BKPyV replication in 62 patients at 1, 3, 6, 9, and 12months after RTX. Sustained significant BK viremia (SSBKV) was defined as significant viremia (≥10000 copies/mL) detected ≥2 times, and BKPyV-associated nephropathy (BKVAN) as histologic changes of BKVAN with BK viremia with/without graft dysfunction. All patients underwent RTX without requiring desensitization. Incidence of BK viremia was: 17.7%, 41.9%, 16.1%, 25.8%, and 17.7% at 1, 3, 6, 9, and 12months, respectively. Of 62 patients, 64.5% had BKPyV viremia during the study, 32.2% had significant viremia, all except one detected in the first 6months. Nine (14.5%) patients had SSBKV. There was no biopsy-proven BKVAN. At the end of 1year, mean serum creatinine was higher and graft dysfunction was significantly more common in patients with SSBKV compared to those without SSBKV. Transient BK viremia is common in low/intermediate immunologic risk RTX recipients in India, with a peak occurring at 3-6months. Most clear their viremia by 12months. Graft dysfunction seems to be more frequent in patients with SSBKV, although BKVAN is uncommon on biopsy in these patients.