The risk factors associated with post-transplantation BKPyV nephropathy and BKPyV DNAemia: a prospective study in kidney transplant recipients

Camilla Lorant; Justina Zigmantaviciute; Naima Ali; Ursa Bonnevier; Mattias Tejde; Bengt von Zur-Mühlen; Britt-Marie Eriksson; Anders Bergqvist; Gabriel Westman

doi:10.1186/s12879-024-09093-7

The risk factors associated with post-transplantation BKPyV nephropathy and BKPyV DNAemia: a prospective study in kidney transplant recipients

BMC Infect Dis. 2024 Feb 22;24(1):245. doi: 10.1186/s12879-024-09093-7.

Authors

Camilla Lorant¹, Justina Zigmantaviciute^{2

3}, Naima Ali³, Ursa Bonnevier⁴, Mattias Tejde⁵, Bengt von Zur-Mühlen⁶, Britt-Marie Eriksson⁷, Anders Bergqvist^#^{2

3}, Gabriel Westman^#⁷

Affiliations

¹ Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, SE-751 85, Uppsala, Sweden. camilla.lorant@medsci.uu.se.
² Department of Medical Sciences, Clinical Microbiology, Uppsala University, Uppsala, Sweden.
³ Clinical Microbiology and Infection Control, Uppsala University Hospital, Uppsala, Sweden.
⁴ Department of Nephrology, Gävle Hospital, Gävle, Sweden.
⁵ Department of Nephrology, Falun Hospital, Falun, Sweden.
⁶ Department of Surgical Sciences, Section of Transplantation Surgery, Uppsala University, Uppsala, Sweden.
⁷ Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, SE-751 85, Uppsala, Sweden.

^# Contributed equally.

Abstract

Background: BK polyomavirus (BKPyV) infection after kidney transplantation can lead to serious complications such as BKPyV-associated nephropathy (BKPyVAN) and graft loss. The aim of this study was to investigate the incidence of BKPyVAN after implementing a BKPyV screening program, to map the distribution of BKPyV genotypes and subtypes in the Uppsala-Örebro region and to identify host and viral risk factors for clinically significant events.

Methods: This single-center prospective cohort study included kidney transplant patients aged ≥ 18 years at the Uppsala University Hospital in Sweden between 2016 and 2018. BKPyV DNA was analyzed in plasma and urine every 3 months until 18 months after transplantation. Also genotype and subtype were determined. A logistic regression model was used to analyze selected risk factors including recipient sex and age, AB0 incompatibility and rejection treatment prior to BKPyVAN or high-level BKPyV DNAemia.

Results: In total, 205 patients were included. Of these, 151 (73.7%) followed the screening protocol with 6 plasma samples, while184 (89.8%) were sampled at least 5 times. Ten (4.9%) patients developed biopsy confirmed BKPyVAN and 33 (16.1%) patients met criteria for high-level BKPyV DNAemia. Male sex (OR 2.85, p = 0.025) and age (OR 1.03 per year, p = 0.020) were identified as significant risk factors for developing BKPyVAN or high-level BKPyV DNAemia. BKPyVAN was associated with increased viral load at 3 months post transplantation (82,000 vs. < 400 copies/mL; p = 0.0029) and with transient, high-level DNAemia (n = 7 (27%); p < 0.0001). The most common genotypes were subtype Ib2 (n = 50 (65.8%)) and IVc2 (n = 20 (26.3%)).

Conclusions: Male sex and increasing age are related to an increased risk of BKPyVAN or high-level BKPyV DNAemia. BKPyVAN is associated with transient, high-level DNAemia but no differences related to viral genotype were detected.

Keywords: BK Polyomavirus (BKPyV); BKPyV genotype; BKPyV risk factors; BKPyV-associated nephropathy (BKPyVAN); Immunosuppression; Kidney transplantation.

MeSH terms

BK Virus* / genetics
Humans
Kidney Diseases* / epidemiology
Kidney Diseases* / etiology
Kidney Transplantation* / adverse effects
Male
Nephritis, Interstitial* / etiology
Polyomavirus Infections* / diagnosis
Prospective Studies
Risk Factors
Transplant Recipients
Tumor Virus Infections* / diagnosis