BK polyomavirus-associated nephropathy may increase the risk for graft loss in kidney transplant recipients, a new study finds.

Among 14,697 kidney transplant recipients from the Australia and New Zealand Dialysis and Transplant registry (ANZDATA), BK polyomavirus-associated nephropathy occurred in 460 patients (3.3%) within a median 4.8 months of transplant surgery. Compared with patients who did not have BK polyomavirus-associated nephropathy, those who did had significantly higher rates of graft loss (35% vs 21%), graft rejection (42% vs 25%), and death (18% vs 13%). In addition, recipients with vs without the nephropathy had a 1.8- and 2.5- fold increased risk of all-cause and death-censored graft loss, respectively, Ryan Gately, MBBS, of Princess Alexandra Hospital in Queensland, Australia, and colleagues reported in Kidney International Reports.

The risk for BK polyomavirus-associated nephropathy was higher for men and recipients aged 70 years or older (vs younger than 20 years), the investigators reported. It developed more often in recipients with blood type A (vs B), tacrolimus use, and transplantation at a low volume center. Older donor age and donor ethnicity mismatch were also associated with higher risks of the condition.

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“The key challenge for transplant clinicians in managing [BK polyomavirus-associated nephropathy] is determining the optimal degree of immunosuppression reduction that prevents viral replication while balancing the risk of inducing allograft rejection,” Dr Gately’s team wrote. They support future trials investigating the relative efficacies of immunosuppression reduction strategies and novel immune-based therapies.


Gately R, Milanzi E, Lim W, et al. Incidence, risk factors, and outcomes of kidney transplant recipients with BK polyomavirus-associated nephropathy. Kidney Int Rep. Published December 29, 2022. doi:10.1016/j.ekir.2022.12.020