Polyomavirus BK-Associated Nephropathy After Kidney Transplantation: A Single-Center Retrospective Analysis

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Abstract

Aim

To evaluate the evolution of BK virus nephropathy in our transplant center Materials: A descriptive, retrospective study of the clinical evolution of BK virus nephropathy in adult kidney transplant patients from 10 / 2011-10 / 2016. The diagnostic suspicion was through the technique of screening and / or renal dysfunction and confirm by kidney biopsy. Screening was performed by Polymerasa Chain Reaction for BKV(+ greater than 10 4 copies / ml) at 2-6-9-12-month and then annually and after the treatment episode due to graft rejection. Patients with a diagnosis of BK nephropathy we decided 1- Reduction of immunosuppression (suspension of mycophenolate by leflunomide and tacrolimus reduction (maintaining dosages average 5ng / ml )or sirolimus, corticoids and leflunomide), and following with 2-Evaluation of renal function,3- Viral load, 4-antiHLA antibodies and 5-Renal biopsy. Half of the patients also received IVIG 400mg / kg / day for 5 days as a treatment.

Results

18/774 renal tx patients had BK nephropathy, at 553 ± 355 days of transplant. 6 for screening and the rest for renal dysfunction. Age 42 ± 12y, 50% women, 14 LD, 4 DD. 6/18 presented previous rejections 2 Mixed 4 cellular Kidney. Biopsies showed Stage I Nephropathy 8 patients (44.4%), S II 9 patients (50%) and S III 1 patient (5.6%). Average basal creatinine (n = 18) 2.5 ± 0.18, 6 months (n = 16) 3.1 ± 1.6, 12 m (n = 15) 2.7 ± 0.8, 24 m (n = 10) 2.62 ± 0.8, 36m (n = 6) 2.9 ± 0.2. 2 patients presented by biopsy, cellular rejection at 3 months of the diagnosis, treated with steroid pulses. No development of de novo antiHLA DSA was observed in this group of patients. The negativization of the viral load BKV was at 3 months in 5 patients and the rest at 6 months. Only 12 renal biopsies were performed(X 12m), presenting an increase in interstitial infiltration and tubulitis in 2 patients). Loss of grafts in 3 patients (16.6%), 2/18 at 4 months and 1/18 at 10 months. There were no deaths.

Conclusions

A low incidence (2,34%) of BK virus nephropathy is observed in this population. There were no differences in the evolution of patients treated with / without IVIG (pNS) especially in the negativization of viral load. Higher percentage of living donors (77%) with BK nephropathy due probably immunosuppression charge and / or unidentified serology of BK virus in donors.

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