Differential impact of allograft rejection on kidney transplant patients with BKV infection
Ji Won Min1, Kang Woong Jun2, Jae Berm Park3, Jung Hwan Park4, Jong-Won Park5, Jaeseok Yang6, Curie Ahn7, Chul Woo Yang8, Byung Ha Chung8.
1Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; 2Department of Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; 3Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 4Department of Nephrology, Konkuk University School of Medicine , Seoul, Korea; 5Department of Nephrology, Yeungnam University Hospital, Seoul, Korea; 6Department of Surgery, Seoul National University Hospital, Seoul, Korea; 7Department of Nephrology, Seoul National University Hospital, Seoul, Korea; 8Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Korean Organ Transplantation Registry Study Group.
Background: BK virus-associated nephropathy (BKVAN) is a known risk factor for allograft dysfunction and graft failure in kidney transplant recipients. The mainstay of treatment for BKVAN is the reduction of immunosuppression and this may increase risk for acute rejection. We proposed to observe the effects of acute rejection on patients with BKVAN.
Methods: Using data from the Korean Organ Transplantation Registry, a nationwide organ transplantation database, we compared graft function and allograft survival in BKVAN patients with or without biopsy-proven acute rejection (BPAR).
Results: Among the 5,403 patients who received kidney transplantation between 2014 and June 2019, a total of 97 patients were diagnosed with BKVAN. Twenty-six patients (27%) developed BPAR within 6 months of BKVAN diagnosis, 71 patients did not. There were no differences in baseline characteristics, immunosuppression or BKVAN treatment methods between the BPAR and no BPAR groups. There was a significant decrease in allograft function in the BPAR group compared to the no BPAR group in both the 1 year (BPAR Cr 2.5±1.9 vs. no BPAR Cr 1.9±0.9, P=0.044) and 2 year follow-up period (BPAR Cr 3.8±3.6 vs. no BPAR Cr 2.2±1.0, P=0.015). The BPAR group had lower allograft survival rates compared to the no BPAR group, although not statistically significant (P=0.474). On multivariate Cox regression analysis, MMF discontinuation was observed as a significant risk factor for rejection in BKVAN patients (Hazard ratio [HR], 4.000; 95% confidence interval [CI], 1.014-15.775; P=0.048).
Conclusion: Acute rejection with BKVAN is associated with poorer allograft function and survival. Also, discontinuation of MMF as treatment for BKVAN increases risk for acute rejection.
Research of Korea Centers for Disease Control and Prevention.
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