Incidence, risk factors, outcomes, and clinical management of BK viremia in the modern era of kidney transplantation

• Published in: Transplant infectious disease Vol. 24; no. 6; p. e13915
• Main Authors: Qeska, Denis, Wong, Rebecca Bic Kay, Famure, Olusegun, Li, Yanhong, Pang, Hilary, Liang, Xin Yun, Zhu, Mary Parker, Husain, Shahid, Kim, Sang Joseph
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.12.2022
• Subjects: Age; BK Virus; Humans; Incidence; Induction therapy; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Polyomavirus Infections - drug therapy; Polyomavirus Infections - epidemiology; Polyomavirus Infections - etiology; Risk analysis; Risk Factors; Risk management; Transplantation, Homologous - adverse effects; Transplants & implants; Tumor Virus Infections - drug therapy; Tumor Virus Infections - epidemiology; Tumor Virus Infections - etiology; Viremia; Viremia - drug therapy; Viremia - epidemiology; viremia; BK virus; kidney transplantation
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.13915

BK viremia is endemic among kidney transplant recipients (KTRs). Incidence, risk factors, outcomes, and clinical management of detectable versus high BK viremia have not been considered previously in KTR in the modern era. This observational study examined KTR transplanted between January 1, 2009 and December 31, 2016. Any BK viral load in the serum constituted detectable BK viremia and ≥10 copies/ml constituted high viremia. Among 1193 KTRs, the cumulative probability of developing detectable and high BK viremia within 2 years posttransplant were 27.8% and 19.6%, respectively. Significant risk factors for detectable BK viremia included recipient age (HR 1.02 [95% CI: 1.01, 1.03]) and donor age (HR 1.01 [95% CI: 1.00, 1.02]). Recipient age also predicted high BK viremia (HR 1.02 [95% CI: 1.01, 1.03]), whereas White race (HR 0.70 [95% CI: 0.52, 0.95]), nondepleting induction therapy (HR 0.61 [95% CI: 0.42, 0.89]), and delayed graft function (HR 0.61 [95% CI: 0.42, 0.88]) were protective. Mean estimated glomerular filtration rates were 4.28 ml/min/1.72 m (95% CI: 2.71, 5.84) lower with detectable BK viremia. Although low viral load was usually not acted upon at first presentation, antiproliferative dose reductions were the most common initial management. BK viremia remains a common early complication in a modern cohort of KTRs. These findings highlight the benefit of early BKV monitoring in addition to intensive clinical management. Clinical responses beyond first positive BK viremia tests, and their implications for graft outcomes, merit further investigation.