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. 2024 May;38(5):e15329.
doi: 10.1111/ctr.15329.

Association of BKV viremia and nephropathy with adverse alloimmune outcomes in kidney transplant recipients

Christie Rampersad  1   2 , Chris Wiebe  3   2 , Robert Balshaw  4 , Jared Bullard  5   6 , Ian W Gibson  7   8 , Aaron Trachtenberg  3   2 , James Shaw  3   2 , Armelle Perez Cortes Villalobos  1   3 , Martin Karpinski  1   3 , Aviva Goldberg  6 , Patricia Birk  6 , Maury Pinsk  6 , David N Rush  3   2 , Peter W Nickerson  3   2   9 , Julie Ho  3   2   9
Affiliations

Association of BKV viremia and nephropathy with adverse alloimmune outcomes in kidney transplant recipients

Christie Rampersad et al. Clin Transplant. 2024 May.

Abstract

Background: Immunosuppression reduction for BK polyoma virus (BKV) must be balanced against risk of adverse alloimmune outcomes. We sought to characterize risk of alloimmune events after BKV within context of HLA-DR/DQ molecular mismatch (mMM) risk score.

Methods: This single-center study evaluated 460 kidney transplant patients on tacrolimus-mycophenolate-prednisone from 2010-2021. BKV status was classified at 6-months post-transplant as "BKV" or "no BKV" in landmark analysis. Primary outcome was T-cell mediated rejection (TCMR). Secondary outcomes included all-cause graft failure (ACGF), death-censored graft failure (DCGF), de novo donor specific antibody (dnDSA), and antibody-mediated rejection (ABMR). Predictors of outcomes were assessed in Cox proportional hazards models including BKV status and alloimmune risk defined by recipient age and molecular mismatch (RAMM) groups.

Results: At 6-months post-transplant, 72 patients had BKV and 388 had no BKV. TCMR occurred in 86 recipients, including 27.8% with BKV and 17% with no BKV (p = .05). TCMR risk was increased in recipients with BKV (HR 1.90, (95% CI 1.14, 3.17); p = .01) and high vs. low-risk RAMM group risk (HR 2.26 (95% CI 1.02, 4.98); p = .02) in multivariable analyses; but not HLA serological MM in sensitivity analysis. Recipients with BKV experienced increased dnDSA in univariable analysis, and there was no association with ABMR, DCGF, or ACGF.

Conclusions: Recipients with BKV had increased risk of TCMR independent of induction immunosuppression and conventional alloimmune risk measures. Recipients with high-risk RAMM experienced increased TCMR risk. Future studies on optimizing immunosuppression for BKV should explore nuanced risk stratification and may consider novel measures of alloimmune risk.

Keywords: HLA eplet mismatch; T‐cell mediated rejection; alloimmune risk; antibody‐mediated rejection; biopsy‐proven acute rejection; death‐censored graft survival; donor specific antibody; graft survival; kidney transplant; polyoma virus.

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References

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