Longitudinal study of BK Polyomavirus outcomes, risk factors, and kinetics in renal transplantation patients

Brandon Dow Chan; Gabriella Wong; Qing Jiang; Magnolia Muk-Lan Lee; Wing-Yan Wong; Feifei Chen; Wing-Tak Wong; Lixing Zhu; Francis Kim-Ming Wong; William Chi-Shing Tai

doi:10.1016/j.micpath.2020.104036

Longitudinal study of BK Polyomavirus outcomes, risk factors, and kinetics in renal transplantation patients

Microb Pathog. 2020 Feb 1:142:104036. doi: 10.1016/j.micpath.2020.104036. Online ahead of print.

Authors

Affiliations

¹ Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R, China.
² Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
³ School of Statistics, Beijing Normal University, Beijing, China.
⁴ School of Statistics, Renmin University of China, Beijing, China.
⁵ Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R, China; State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
⁶ Department of Mathematics, The Hong Kong Baptist University, Kowloon Tong, Hong Kong S.A.R, China.
⁷ Medical and Renal Centre, Kowloon, Hong Kong S.A.R, China.
⁸ Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong S.A.R, China; State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China. Electronic address: william-cs.tai@polyu.edu.hk.

PMID: 32017958
DOI: 10.1016/j.micpath.2020.104036

Abstract

Background: In the immunocompromised conditions following renal transplantation, BK virus can reactivate and cause BK virus associated nephropathy (BKVN). Increased BK viral loads and extended duration of infection have been linked to development of BKVN. The aim of this study was to observe the incidence of BKV infection and BKVN, and kinetics of infection and disease in renal transplantation recipients.

Methods: From 2014 to 2018, we conducted a longitudinal cohort observational study of 139 renal transplantation patients treated at a single clinic. Quantitative PCR assay was conducted to assess longitudinal BK viral loads. Analysis of patient clinical characteristics was performed to determine risk factors for BKV infection and associated disease.

Results: Of our cohort, 29 (20.9%) patients developed high BK viremia, and 7 (5.0%) developed biopsy-confirmed BKVN. Clinical parameters associated with diabetes (FBS, HbA1c) and hyperlipidemia (TG, TC, LDL-C) were found to be correlated with development of high BK viremia or BKVN. In 3 of 4 patients receiving intravenous immunoglobulin (IVIG) treatment, BK viral loads were reduced by at least 1 log within 2-3 months of administration. Significant differences were measured in BK viral loads and kidney function between BK viremic patients and BKVN patients by 3-9 months post-transplantation.

Conclusions: We identified diabetes and hyperlipidemia as potential risk factors for development of high BK viremia and/or BKVN. IVIG was seen to be effective in reducing viral titers. The period 3-9 months post-transplantation was identified as important for development of BKVN from high BK viremia.

Keywords: BK virus; BK virus associated nephropathy; Intravenous immunoglobulin; Kinetics; Risk factors.