Abstract
BK virus associated nephropathy (BKN) is an important cause of kidney allograft failure. In a cohort of paediatric kidney transplant recipients, we aimed to understand the incidence and clinical outcome associated with BKN, as well as identify risk factors for BKN and BK viraemia development. We retrospectively analysed all patients who received a kidney transplant and received follow up care in our centre between 2009–2019. Among 106 patients included in the study (mean follow up 4.5 years), 32/106 (30.2%) patients experienced BK viraemia. The incidence of BKN was 7/106 (6.6%). The median time of BK viraemia development post-transplant was 279.5 days compared to 90.0 days for BKN. Development of BKN was associated with younger age at transplantation (p = 0.013). Development of BK viraemia was associated with negative recipient serology for cytomegalovirus (CMV) at time of transplantation (p = 0.012) and a higher net level of immunosuppression (p = 0.039). There was no difference in graft function at latest follow up between those who experienced BKN and those without BKN. This study demonstrates that BK virus infection is associated with younger age at transplantation, CMV negative recipient serostatus and higher levels of immunosuppression. Judicious monitoring of BK viraemia in paediatric transplant recipients, coupled with timely clinical intervention can result in similar long-term outcomes for BKN patients compared to controls.
Highlights
BK virus associated nephropathy (BKN) is an important cause of kidney allograft failure
The salient findings of this study involving 106 paediatric kidney transplant recipients are as follows: (1) 2/106 individuals experienced BKNB+ and 5/106 patients developed BKNHi, giving an overall BKPyV-associated nephropathy (BKN) incidence of 7/106 (6.6%); (2) 30.2% patients experienced BKPyV viraemia; (3) the incidences of B KNLow, BKNB+ and B KNHi were highest during the first year post-transplant; (4) 23.5% of BKNLow episodes occurred after 2 years post-transplantation; (5) there was no significant difference in long-term graft function between patients experiencing BKPyV
Viraemia/BKN and no-BK controls; (6) younger age at transplantation, CMV negative serology of the allograft recipient at time of transplantation, and a higher level of immunosuppression were associated with an increased risk of BKN/ BKPyV viraemia development
Summary
BK virus associated nephropathy (BKN) is an important cause of kidney allograft failure. In a cohort of paediatric kidney transplant recipients, we aimed to understand the incidence and clinical outcome associated with BKN, as well as identify risk factors for BKN and BK viraemia development. Development of BK viraemia was associated with negative recipient serology for cytomegalovirus (CMV) at time of transplantation (p = 0.012) and a higher net level of immunosuppression (p = 0.039). This study demonstrates that BK virus infection is associated with younger age at transplantation, CMV negative recipient serostatus and higher levels of immunosuppression. Reported risk factors for the development of BKN in the paediatric population include allograft recipient BKPyV seronegativity at time of transplantation[20,23], zero human leukocyte antigens (HLA) -A and -DR mismatches between transplant donor and recipient[22], increased levels of immunosuppression,[8,21]
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