Clinical Impact of BK Virus Surveillance on Outcomes in Kidney Transplant Recipients S.-H. Yoona, J.-H. Chob, H.-Y. Jungb, J.-Y. Choib, S.-H. Parkb, Y.-L. Kimb, H.-K. Kimc, S. Huhc, and C.-D. Kimb,* a Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea; bDepartment of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea; and cDepartment of Surgery, Kyungpook National University School of Medicine, Daegu, Korea

ABSTRACT Background. The objective of this study was to investigate the clinical impact of BK virus surveillance on graft injury in kidney transplantation. Methods. BK viremia in kidney transplant recipients was evaluated by use of plasma quantitative polymerase chain reaction. The prevalence of BK viremia and BK viruse associated nephropathy (BKVAN) and the clinical impact of BK viremia on graft outcomes were assessed. Results. This study took place between January 2008 and June 2013. A total of 213 kidney transplant recipients were included. The prevalence of BK viremia and high BK viremia (1  104 copies/mL) was 66.7% (142/213) and 17.4% (37/213), respectively. A diagnosis of BKVAN was confirmed by means of allograft biopsy in 9 patients (4.2%). The estimated glomerular filtration rate after transplantation was similar in both the low BK viremia (92,850 copies/mL was able to predict BKVAN with 89% sensitivity and 94.6% specificity. The risk factors for viral loads 1  104 copies/mL were cytomegalovirus infection, steroid pulse therapy, and acute rejection. Conclusions. High BK viremia was associated with poor graft function after kidney transplantation. The serial monitoring of BK viremia in kidney transplant recipients was helpful in predicting BKVAN and might prevent further progression.

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RAFT survival after kidney transplantation has improved with recent developments in immunosuppressive regimens [1]. However, the incidence of opportunistic infections, such as BK viremia, has also increased [2]. BK viruseassociated nephropathy (BKVAN) is a serious complication of kidney transplantation, and half of all cases result in graft loss [3,4]. The gold standard test for establishing a diagnosis of BKVAN is kidney biopsy, but it is invasive and by the time pathological changes are seen in the grafted kidney, it is usually too late to reverse the outcome. Because BK viremia precedes BKVAN, monitoring of viremia and predicting the risk of BKVAN are important issues for the management of clinical disease, and 0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2014.11.051

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it is reported that a screening program may improve outcome and prevent allograft loss [5e7]. In the early 2000s, a real-time polymerase chain reaction (PCR) viral load assay with the use of urine and plasma samples was introduced for detecting BK virus replication. This work was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI13C1232). *Address correspondence to Chan-Duck Kim, MD, PhD, Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea. E-mail: [email protected] ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710

Transplantation Proceedings, 47, 660e665 (2015)

CLINICAL IMPACT OF BK VIRUS SURVEILLANCE

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Table 1. Demographic and Clinical Characteristics of Kidney Transplant Recipients NoneBK Viremia (n ¼ 71)

Low-BKViremia

Clinical impact of BK virus surveillance on outcomes in kidney transplant recipients.

The objective of this study was to investigate the clinical impact of BK virus surveillance on graft injury in kidney transplantation...
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