Isolated heart and liver transplant recipients are at low risk for polyomavirus BKV nephropathy

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Abstract

Background

BKV infection and nephropathy is a significant cause of allograft dysfunction in kidney transplantation. BKV viremia, rather than viruria, corresponds to BKV nephropathy. The prevalence of BKV viremia in non-renal solid organ transplants has not been systematically evaluated.

Methods

We determined prevalence of BKV viremia in kidney, combined kidney–heart, kidney–liver, kidney–pancreas, kidney–heart–liver, and heart and liver transplant recipients using BKV-PCR.

Results

Seven out of 173 (4%) kidney transplant recipients had BKV viremia, with BKV>2 × 105 copies/mL in 6/7 and 1.9 × 103 in the remaining one patient. BKV viremia was not found in 24 heart transplant recipients, whereas 1/37 (2.7%) liver transplants showed low copy numbers (≤103). BKV-PCR≤103 copies/mL were also found in one of each combined kidney–heart and kidney–liver transplant recipients. BKV nephropathy was proven by biopsy in 4/6 patients with high BKV viral loads. All six patients showed renal dysfunction, requiring reduction in immunosuppression and antiviral therapy. All four patients with low BKV viral loads (1.9 × 103 or ≤103) showed stable renal function after reduction of immunosuppression or no treatment, respectively.

Conclusion

Higher BKV levels in plasma are associated with renal dysfunction. Kidney transplant recipients are at high risk compared with recipients of isolated heart or liver allografts, for development of BKV nephropathy.

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