Active Surveillance for BK Virus May Help Minimize Nephropathy in Kidney Transplant Recipients

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This article is part of our ongoing coverage of Renal Week 2009. Click here for a complete list of our Renal Week Live articles.


Key Points

  • Active surveillance for BK virus with prompt reduction in immunosuppression therapy may help minimize graft loss due to BK nephropathy.
  • Renal infection with BK virus is associated with poor allograft survival.
  • It frequently leads to graft loss when it occurs in the presence of renal dysfunction, despite reduction of immunosuppression.

Active surveillance for BK virus with prompt reduction in immunosuppression therapy may help minimize graft loss due to BK nephropathy, according to researchers who presented their study at ASN's Renal Week 2009.

“If you get this virus it is sort of a sign of over immunosuppression,” lead investigator William Bennett, MD, Medical Director of Renal Transplantation at Legacy Good Samaritan Hospital, Portland, Ore., told Renal & Urology News. “So we have been routinely surveying patients after transplantation for the presence of this virus by detecting the viral antigens in the urine.”

Renal infection with BK virus is associated with poor allograft survival, Dr. Bennett said. It frequently leads to graft loss when it occurs in the presence of renal dysfunction, despite reduction of immunosuppression.

The researchers looked at whether catching the problem earlier could lead to better outcomes. Using plasma and urine polymerase chain reaction (PCR) testing, they prospectively followed 124 consecutive renal transplant recipients for BK infection.

Twenty-two patients (18%) had a positive plasma PCR test at a mean of 17 weeks (range 4-52 weeks) post-transplant. All 22 patients received a reduction in immunosuppresion.

Viremia resolved in three months or less in 20 of the 22 patients with no antiviral therapy. Eight patients had biopsy-proven rejection episodes during reduced immunosuppression; viremia developed in two patients following treatment for acute rejection.

Overall, the researchers observed no graft loss due to rejection. Patient survival was 99% and graft survival was 98%, with no graft loss due to BK nephropathy.

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