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. 2016 May;16(5):1492-502.
doi: 10.1111/ajt.13635. Epub 2016 Mar 2.

Symptomatic BK Virus Infection Is Associated With Kidney Function Decline and Poor Overall Survival in Allogeneic Hematopoietic Stem Cell Recipients

A Abudayyeh  1 , A Hamdi  1 , H Lin  2 , M Abdelrahim  3 , G Rondon  4 , B S Andersson  4 , A Afrough  4 , C S Martinez  4 , J J Tarrand  5 , D P Kontoyiannis  6 , D Marin  4 , A O Gaber  7 , A Salahudeen  8 , B Oran  4 , R F Chemaly  6 , A Olson  4 , R Jones  4 , U Popat  4 , R E Champlin  4 , E J Shpall  4 , W C Winkelmayer  9 , K Rezvani  4
Affiliations

Symptomatic BK Virus Infection Is Associated With Kidney Function Decline and Poor Overall Survival in Allogeneic Hematopoietic Stem Cell Recipients

A Abudayyeh et al. Am J Transplant. 2016 May.

Abstract

Nephropathy due to BK virus (BKV) infection is an evolving challenge in patients undergoing hematopoietic stem cell transplantation (HSCT). We hypothesized that BKV infection was a marker of kidney function decline and a poor prognostic factor in HSCT recipients who experience this complication. In this retrospective study, we analyzed all patients who underwent their first allogeneic HSCT at our institution between 2004 and 2012. We evaluated the incidence of persistent kidney function decline, which was defined as a confirmed reduction in estimated glomerular filtration rate of at least 25% from baseline using the Chronic Kidney Disease Epidemiology equation. Cox proportional hazard regression was used to model the cause-specific hazard of kidney function decline, and the Fine-Gray method was used to account for the competing risks of death. Among 2477 recipients of a first allogeneic HSCT, BK viruria was detected in 25% (n = 629) and kidney function decline in 944 (38.1%). On multivariate analysis, after adjusting for age, sex, acute graft-versus-host disease (GVHD), chronic GVHD, preparative conditioning regimen, and graft source, BK viruria remained a significant risk factor for kidney function decline (p < 0.001). In addition, patients with BKV infection and kidney function decline experienced worse overall survival. After allogeneic HSCT, BKV infection was strongly and independently associated with subsequent kidney function decline and worse patient survival after HSCT.

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Conflict of interest statement

Disclosure

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. The other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Population Flow Diagram
Figure 2
Figure 2
A, 2C, 2D: Kaplan-Meier curves indicating progression to KFD, overall survival and BK infection. 2B cumulative incidence of KFD. KFD: chronic kidney disease, OS: overall survival.
See this image and copyright information in PMC

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