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. 2019 Feb;132(4):388-394.
doi: 10.1097/CM9.0000000000000085.

Prognosis of BK polyomavirus nephropathy: 10-year analysis of 133 renal transplant recipients at a single center

Xu-Tao Chen  1 , Shi-Cong Yang  2 , Jun Li  1 , Rong-Hai Deng  1 , Wen-Fang Chen  2 , Jiang Qiu  1 , Li-Zhong Chen  1 , Chang-Xi Wang  1 , Gang Huang  1
Affiliations

Prognosis of BK polyomavirus nephropathy: 10-year analysis of 133 renal transplant recipients at a single center

Xu-Tao Chen et al. Chin Med J (Engl). 2019 Feb.

Abstract

Background: BK virus-associated nephropathy (BKVN) is an important cause of chronic allograft dysfunction. The objective of our study was to evaluate the prognosis of BKVN.

Methods: We retrospectively reviewed the data of 133 renal transplant recipients with BKVN treated at the First Affiliated Hospital of Sun Yat-Sen University between July 2007 and July 2017. BK viral loads, graft function, and pathologic indexes were compared between initial diagnosis and last follow-up.

Results: After a mean follow-up period of 14.4 (range, 0.3-109.6) months after diagnosis of BKVN, BK viruria, and BK viremia become negative in 19.5% and 90.2% of patients, respectively. The mean estimated glomerular filtration rate (eGFR) at last follow-up was lower than at diagnosis of BKVN (18.3 ± 9.2 vs. 32.8 ± 20.6 mL·min·1.73 m, t = 7.426, P < 0.001). Eight (6.0%) patients developed acute rejection after reducing immunosuppression. At last follow-up, the eGFR was significantly lower in patients with subsequent rejection than those without (21.6 ± 9.8 vs. 33.5 ± 20.9 mL·min·1.73 m, t = 3.034, P = 0.011). In 65 repeat biopsies, SV40-T antigen staining remained positive in 40 patients and became negative in the other 20 patients. The eGFR (42.6 ± 14.3 vs. 26.5 ± 12.3 mL·min·1.73 m), urine viral loads (median, 1.3 × 10vs. 1.4 × 10 copies/mL), and plasma viral load (median, 0 vs. 0 copies/mL) were all significantly lower in patients with negative SV40-T antigen staining than those with persistent BK involvement (all, P < 0.05). Five (3.8%) recipients lost their graft at diagnosis of BKVN, and 13 (9.8%) lost their graft during the follow-up period. The 1-, 3-, and 5-year graft survival rates after diagnosis of BKVN were 99.2%, 90.7%, and 85.7%, respectively. Higher pathologic stage correlated with lower allograft survival rate (χ = 6.341, P = 0.042).

Conclusion: Secondary rejection and persistent histologic infection in BKVN lead to poor prognosis.

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Figures

Figure 1
Figure 1
Kaplan-Meier estimate of death-censored graft survival in patients with stage A, B, and C BK virus-associated nephropathy.
See this image and copyright information in PMC

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