Abstract
Objectives: BK virus (BKV) infection has become one of the main complications in renal transplant recipients (RTRs) with the arrival of newer potent immunosuppressive agents. However, reports on the epidemiology of BKV infection and risk factors in Chinese population after renal transplantation are scarce.Methods: From June 2015 to July 2016, living-donor renal transplant recipients (LDRTRs) who routinely received the quantitative BKV DNA testing of urine and plasma samples using quantitative real-time polymerase chain reaction (PCR) for the first time after transplantation were selected, while dialysis patients and healthy living donors during that period served as controls. Potential variables were compared and analyzed using logistic regression model multivariate analysis to assess the BKV infection related factors in LDRTRs.Results: Among the 52 LDRTRs identified, BKV DNA was detected in 16 urine samples (30.8%), significantly higher than that of dialysis patients (6.3%) and healthy living donors (4.2%) (p < .001). Nevertheless, no statistically significant difference wax noted between the latter two groups in urine samples (p = .842). Meanwhile, BKV DNA detection in blood samples was all negative in the three groups. Univariate analysis shown tacrolimus (Tac) trough level and lymphocyte percentage were associated with BKV infection in LDRTRs. Multivariate regression analysis also showed Tac trough level (HR, 1.644; p = .03), lymphocyte percentage (HR, 0.878; p = .026) were associated with BKV infection in LDRTRs.Conclusions: In Chinese population, the incidence of BKV infection increased significantly after living-donor renal transplantation. Significantly increased Tac trough level and decreased lymphocyte percentage might be the risk factors for BKV infection in LDRTRs.
Highlights
Human polyomavirus BK is a circular double-stranded DNA virus which was first reported in 1971 [1,2]
The mean creatinine at the time of BK virus (BKV) positivity was 1.31 ± 0.25 mg/dl, and the duration from BKV positivity to renal transplantation was 0.5–50.5 months, among which 75% were within 6 months post-transplant, 12.5% were between 6 and 24 months post-transplant, and the rest were more than 24 months post-transplant
With the introduction of more potent immunosuppressive regimens, BKV infection has emerged as a major complication in renal transplantation recipients, often leading to graft loss [2,4,8]
Summary
Human polyomavirus BK is a circular double-stranded DNA virus which was first reported in 1971 [1,2]. It is ubiquitous in healthy adults with a reported seroprevalence of >80% [3]. BKV establishes latency in the uroepithelium and renal tubular epithelial cells where replication was controlled by the immune system. With the introduction of new and potent immunosuppressive regimens, BKV infection rate increased gradually with BKVAN being a feared complication following kidney transplantation. A variety of risk factors for BKV infection have been reported, which included patient characteristics, quality of the allograft and introduction of immunosuppressive regimens. The most consistently reported risk factor is immunosuppression with other risk factors being questioned
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