Clinical features of BK-polyomavirus and cytomegalovirus co-infection after kidney transplantation

Ulrich Jehn,Stefan Reuter,Joachim Bautz,Katharina Schütte-Nütgen,Barbara Suwelack,Gerold Thölking,Hermann Pavenstädt

doi:10.1038/s41598-020-79799-6

Abstract

BK polyomavirus (BKPyV) and cytomegalovirus (CMV) are the main viral pathogens affecting the graft and recipient outcome after allogenic kidney transplantation. It has recently been found that infection with both viruses has a greater impact on kidney graft function than a single infection. We retrospectively analyzed a cohort of 723 recipients who received kidney transplantation between 2007 and 2015 after living and postmortal donation for differences in risk and outcome parameters regarding BKPyV (DNAemia) and CMV (CMV DNAemia) co-infection compared to sole viremias and to patients without viremia. Of all kidney allograft recipients in our cohort, 8.2% developed co-infection with BKPyV DNAemia and CMV DNAemia, 15.1% showed BKPyV viremia alone and 25.2% sole CMV DNAemia. Acute rejection was closely linked with co-infection (multivariable analysis, p = 0.001). Despite the fact that the estimated glomerular filtration rate of patients with co-infection was noticeably reduced compared to patients with BKV or CMV infection alone, transplant survival and patient survival were not significantly reduced. Co-infection with BKPyV and CMV in kidney transplanted patients is significantly associated with inferior allograft function. Since co-infection is strongly associated with acute rejection, co-infected individuals should be considered a risk collective.

Highlights

BK polyomavirus (BKPyV) and cytomegalovirus (CMV) are the main viral pathogens affecting the graft and recipient outcome after allogenic kidney transplantation
The patient collective was divided into four subgroups, according to the constellation of CMV and BKPyV DNAemia (Fig. 1)
Blazquez-Navarro et al recently found a superiority of BKPyV infection over CMV from the epidemiological point of v iew[12]

Summary

Introduction

BK polyomavirus (BKPyV) and cytomegalovirus (CMV) are the main viral pathogens affecting the graft and recipient outcome after allogenic kidney transplantation. Transplant immanent immunosuppressive therapy leads to (re-)activation of these common pathogens, which are normally latent in healthy individuals, so that they can cause a clinically relevant primary infection or, in most cases, re-activation Both viral infections can manifest as viremia or lead to an invasive organ disease. The authors observed that a combined CMV-BKPyV infection, regardless of which virus was first detected, resulted in reduced graft function 1 year after KTx, even at low viral load. They concluded that the combined reactivation of CMV-BKPyV is a relevant complication of the post-transplant period with an unfavorable p rognosis[12]. Since there is only very limited data about CMV-BKPyV infections after KTx and since there is no log-term data beyond the first post-transplant year available, we conducted the present study

Methods

Results

Conclusion