The Clinical Impact of BK Virus Surveillance On Outcomes in Kidney Transplant Recipients.

Abstract

Purpose: The objective of this study was to investigate the clinical impact of BK virus surveillance to prevent BK virus-associated graft injury in kidney transplantation. Methods: We evaluated the prevalence of BK viremia using plasma quantitative polymerase chain reaction (PCR) and BK virus associated nephropathy (BKVAN) and the clinical impact of BK viremia on graft outcomes in the kidney transplant recipients between January 2008 and June 2013. Results: In this study, 1136 tests from 423 kidney transplant recipients were performed. The prevalence of BK viremia and high BK viremia (>1X104 copies/mL) were 60.3% (255/423) and 13.5% (57/423) respectively. Nine cases were finally diagnosed as BKVAN by allograft biopsy. Although low BK viremia (<1X104 copies/mL) group had comparable creatinine levels after transplantation, high BK viremia group showed significantly higher creatinine levels at 6, 12 and 18 months after transplantation when compared with no viremia group. In receiver operating characteristic curve analysis, area under the curve of peak BK viremia for the diagnosis of BKVAN was 0.986. We found 92,850 copies/mL was significant cut-off level to predict BKVAN with 89% sensitivity and 97% specificity. Conclusion: High BK viremia was associated with poor graft function after kidney transplantation. The serial monitoring of BK viremia in kidney transplant recipients was helpful to predict BKVAN and might prevent further progression.