Document Detail


Screening for BK viremia reduces but does not eliminate the risk of BK nephropathy: a single-center retrospective analysis.
MedLine Citation:
PMID:  23545506     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: This study reviewed the outcomes of a screening protocol for BK viremia to determine if early diagnosis, followed by immunosuppression minimization, would prevent progression to nephropathy and graft loss.
METHODS: This review included 369 renal transplant recipients tested for BK virus at serial time points after transplantation. Management included immunosuppression minimization plus cidofovir treatment for BK nephropathy.
RESULTS: Recipients received tacrolimus-based immunosuppression, with 8% prednisone-free and 6% who received desensitization. With a mean follow-up of 22 ± 10 months, 16% (n = 57) of recipients became BK viremia positive. The median (range) time to diagnosis was 3 (1-17) months. Because renal biopsy was performed selectively, 59% of recipients underwent biopsy, with 47% showing BK nephropathy. Seventy-four percent of recipients cleared the virus at a median (range) time of 9 (3-33) months, with four grafts lost to BK nephropathy. Cidofovir-treated recipients displayed a higher viral load at diagnosis but showed equivalent renal function at last evaluation. In multivariate analysis, recipient age, Asian ethnicity, deceased donor, and prednisone use were factors independently associated with BK viremia. Actuarial survival of BK-positive grafts was worse than that of BK-negative grafts (P<0.01, log-rank test). At 9 and 12 months, the mean estimated glomerular filtration rate of the BK-positive group was lower than that of the BK-negative cohort (P = 0.02).
CONCLUSIONS: Despite using a screening protocol combined with immunosuppression minimization, BK-positive recipients had a greater risk of graft loss and impaired function than recipients free of infection. Future investigations should focus on practices to prevent BK viremia.
Authors:
Richard J Knight; Lillian W Gaber; Samir J Patel; Jennifer M DeVos; Linda W Moore; A Osama Gaber
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation     Volume:  95     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-02     Completed Date:  2013-07-08     Revised Date:  2013-11-18    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  949-54     Citation Subset:  IM    
Affiliation:
Department of Surgery, The Methodist Hospital, Houston, TX 77030, USA. rjknight@tmhs.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Antiviral Agents / therapeutic use
BK Virus / genetics,  isolation & purification*
Biopsy
Cytosine / analogs & derivatives,  therapeutic use
Early Diagnosis
Female
Glomerular Filtration Rate
Graft Survival
Humans
Immunosuppressive Agents / adverse effects*
Kaplan-Meier Estimate
Kidney Diseases / diagnosis,  immunology,  prevention & control*,  virology
Kidney Transplantation / adverse effects,  immunology*
Logistic Models
Male
Mass Screening* / methods
Middle Aged
Multivariate Analysis
Organophosphonates / therapeutic use
Polyomavirus Infections / diagnosis*,  immunology,  virology
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Texas
Time Factors
Tumor Virus Infections / diagnosis*,  immunology,  virology
Viral Load
Viremia / diagnosis*,  immunology,  virology
Young Adult
Chemical
Reg. No./Substance:
0/Antiviral Agents; 0/Immunosuppressive Agents; 0/Organophosphonates; 71-30-7/Cytosine; JIL713Q00N/cidofovir
Comments/Corrections
Comment In:
Transplantation. 2013 Oct 15;96(7):e50   [PMID:  24100843 ]
Transplantation. 2013 Oct 15;96(7):e51   [PMID:  24100844 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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