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. 2023 Feb 6;23(1):74.
doi: 10.1186/s12879-023-08043-z.

Characteristics, risk factors and outcome of BKV nephropathy in kidney transplant recipients: a case-control study

Julien Gras #  1   2   3 , Arnaud Le Flécher #  4 , Axelle Dupont  5 , Jérôme Vérine  6 , Ali Amara  7 , Constance Delaugerre  7   8   9 , Jean Michel Molina  10   7   8 , Marie Noëlle Peraldi  8   4
Affiliations

Characteristics, risk factors and outcome of BKV nephropathy in kidney transplant recipients: a case-control study

Julien Gras et al. BMC Infect Dis. .

Abstract

Background: Following kidney transplantation, BK virus associated nephropathy (BKVN) occurs in 1 to 10% of kidney transplant recipients (KTR) and represents a major cause of graft loss. We aim at identifying factors associated with biopsy proven BKVN among KTR.

Methods: We conducted a retrospective case-control study including all KTR with a biopsy-proven diagnosis of BKVN between 2005 and 2019. Clinical characteristics and outcome were described. For each case, one control KTR without BKV infection was identified and matched by age, transplant date, and donor status. Factors associated with BKVN diagnosis were identified using exact conditional logistic regression. Comparative survival was described using Kaplan-Meier estimator.

Results: Sixty-four cases of BKVN were identified among 1737 new kidney transplantation (3.7% prevalence). Clinical characteristics did not differ between groups, except for a higher c-PRA among cases. BKVN occurred in a median time of 11 (5-14.5) months after KT, and was associated with a significantly impaired graft function at diagnosis. Following BKVN, 61 (95%) of the patients had immunosuppression reduction, which led to BKV DNAemia resolution in 49% of cases. In multivariate analysis, factors associated with BKVN diagnosis were lymphopenia < 500/mm3 and a prednisone dose > 7.5 mg/day. Median duration of follow-up was 40 months for both groups. BKVN was associated with a significantly increased risk of graft rejection (P = 0.02) and return to dialysis (P = 0.01).

Conclusions: BKVN remains a severe complication in KTR and is associated with an increased risk for acute rejection and return to dialysis. Lymphopenia below 500/mm3 and corticosteroid maintenance therapy are significantly associated with biopsy-proven BKVN diagnosis.

Keywords: BK virus; BKV associated nephropathy; Kidney transplantation; Risk factors.

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Conflict of interest statement

All authors declare no competing interest for this work.

Figures

Fig. 1
Fig. 1
Comparative event-free survival curves between BKVN cases and matched controls for acute rejection episodes (A) and return to dialysis (B). Survival and event-free survival curves were obtained using Kaplan–Meier plots with censoring for loss to follow-up or end of observation for survival without rejection (A) and survival without dialysis (B). Comparison between cases and controls were made using log-rank tests
See this image and copyright information in PMC

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