Abstract
<h3>Purpose</h3> BK virus (BKV) after kidney transplant is associated with decreased graft survival, increased morbidity, and increased health-care costs. Management of BKV post-transplant remains difficult, especially in dual organ transplants where immunosuppression requirements are typically higher and limited evidence exists. Our aim was to describe our experience with simultaneous heart-kidney transplant (HKT) recipients who developed BKV. <h3>Methods</h3> This was a single-center case series of HKT recipients between 11/2015 and 11/2019. Data are presented as median (IQR) or percentages, as appropriate. The primary endpoint was the incidence of BK viremia within 12-months post-transplant. <h3>Results</h3> Of the 12 patients included, 5 (41.7%) developed BKV at a median time of 196 (85-258) days. Baseline demographics and clinical outcomes are included in Table 1. Patients who experienced BKV were more likely to receive rabbit anti-thymocyte globulin for induction (p=0.04). There was no statistical difference in maintenance immunosuppression; however, mycophenolate dose and tacrolimus troughs were numerically higher at 3 months post-transplant in patients with BKV. All 5 patients were treated with a reduction in maintenance immunosuppression. Additionally, three (60%) received intravenous immune globulin, three (60%) received cidofovir, and three (60%) were switched to sirolimus. Although not statistically significant, eGFR was numerically lower starting at 3-months post-transplant in patients with BKV. Only one (20%) patient developed biopsy-confirmed BK nephropathy. <h3>Conclusion</h3> BKV is an underappreciated complication post-HKT. The high incidence may be explained by lymphocyte-depleting induction and increased maintenance immunosuppression in this group. Although BKV did not impact patient or graft survival, added vigilance may be warranted. Long-term follow-up is required to help identify appropriate management strategies for this complication.
Published Version
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