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Risk factors in the progression of BK virus-associated nephropathy in renal transplant recipients.

Lee HM, Jang IA, Lee D, Kang EJ, Choi BS, Park CW, Choi YJ, Yang CW, Kim YS, Chung BH - Korean J. Intern. Med. (2015)

Bottom Line: BK virus-associated nephropathy (BKVAN) is an important cause of allograft dysfunction in kidney transplant recipients.Advanced stages of BKVAN, increased creatinine levels, and accompanying acute rejection at the time of BKVAN diagnosis increased the risk of allograft failure.The clinical outcomes in patients with biopsy-proven BKVAN were unfavorable in the present study, especially in patients with advanced-stage BKVAN, poor renal function, and acute allograft rejection.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background/aims: BK virus-associated nephropathy (BKVAN) is an important cause of allograft dysfunction in kidney transplant recipients. It has an unfavorable clinical course, and no definite treatment guidelines have yet been established. Here, we report our center's experience with biopsy-proven BKVAN and investigate factors associated with its progression.

Methods: From January 2004 to April 2013, 25 patients with BKVAN were diagnosed by biopsy at Seoul St. Mary's Hospital. Of the 25 patients, 10 were deceaseddonor transplant recipients and 15 were living-donor transplant recipients. Three of the patients underwent retransplantation. The primary immunosuppressant used was tacrolimus in 17 patients and cyclosporine in eight patients.

Results: BKVAN was observed at a mean duration of 22.8 ± 29.1 months after transplantation. The mean serum creatinine level at biopsy was 2.2 ± 0.7 mg/dL. BKVAN occurred with acute rejection in eight patients (28%). Immunosuppression modification was performed in 21 patients (84%). Additionally, leflunomide and intravenous immunoglobulin were administered to 13 patients (52%) and two (8%), respectively. Allograft loss occurred in five patients (27.8%) during the follow- up period at 0.7, 17.1, 21.8, 39.8, and 41.5 months after the BKVAN diagnosis. Advanced stages of BKVAN, increased creatinine levels, and accompanying acute rejection at the time of BKVAN diagnosis increased the risk of allograft failure.

Conclusions: The clinical outcomes in patients with biopsy-proven BKVAN were unfavorable in the present study, especially in patients with advanced-stage BKVAN, poor renal function, and acute allograft rejection.

No MeSH data available.


Related in: MedlinePlus

Changes in allograft function and allograft survival rate after BK virus-associated nephropathy (BKVAN) diagnosis. (A) Allograft function deteriorated after BKVAN diagnosis. (B) The 5-year allograft survival rate from biopsy was 67% using Kaplan-Meier analysis.
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f1-kjim-30-6-865: Changes in allograft function and allograft survival rate after BK virus-associated nephropathy (BKVAN) diagnosis. (A) Allograft function deteriorated after BKVAN diagnosis. (B) The 5-year allograft survival rate from biopsy was 67% using Kaplan-Meier analysis.

Mentions: The follow-up duration after BKVAN diagnosis was 29.9 months (range, 0.7 to 90.1). The immunosuppression regimen was modified in 21 patients. Mycophenolate mofetil was discontinued in all patients, and the tacrolimus dose was reduced by 20% in nine patients. Leflunomide was used in 13 patients, and infused intravenous immunoglobulin (IVIG) was used for 5 days in four patients. Despite the change in immunosuppressant or treatment for BKVAN, the allograft function did not improve overall (Fig. 1A). In five patients, allograft rejection developed within 6 months of the BKVAN diagnosis. During the follow-up period, 20% (5/25) of the patients experienced allograft loss at 21.8 months (range, 0.7 to 41.5) from BKVAN diagnosis. The 5-year allograft survival rate from BKVAN diagnosis was 67% (Fig. 1B).


Risk factors in the progression of BK virus-associated nephropathy in renal transplant recipients.

Lee HM, Jang IA, Lee D, Kang EJ, Choi BS, Park CW, Choi YJ, Yang CW, Kim YS, Chung BH - Korean J. Intern. Med. (2015)

Changes in allograft function and allograft survival rate after BK virus-associated nephropathy (BKVAN) diagnosis. (A) Allograft function deteriorated after BKVAN diagnosis. (B) The 5-year allograft survival rate from biopsy was 67% using Kaplan-Meier analysis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4642016&req=5

f1-kjim-30-6-865: Changes in allograft function and allograft survival rate after BK virus-associated nephropathy (BKVAN) diagnosis. (A) Allograft function deteriorated after BKVAN diagnosis. (B) The 5-year allograft survival rate from biopsy was 67% using Kaplan-Meier analysis.
Mentions: The follow-up duration after BKVAN diagnosis was 29.9 months (range, 0.7 to 90.1). The immunosuppression regimen was modified in 21 patients. Mycophenolate mofetil was discontinued in all patients, and the tacrolimus dose was reduced by 20% in nine patients. Leflunomide was used in 13 patients, and infused intravenous immunoglobulin (IVIG) was used for 5 days in four patients. Despite the change in immunosuppressant or treatment for BKVAN, the allograft function did not improve overall (Fig. 1A). In five patients, allograft rejection developed within 6 months of the BKVAN diagnosis. During the follow-up period, 20% (5/25) of the patients experienced allograft loss at 21.8 months (range, 0.7 to 41.5) from BKVAN diagnosis. The 5-year allograft survival rate from BKVAN diagnosis was 67% (Fig. 1B).

Bottom Line: BK virus-associated nephropathy (BKVAN) is an important cause of allograft dysfunction in kidney transplant recipients.Advanced stages of BKVAN, increased creatinine levels, and accompanying acute rejection at the time of BKVAN diagnosis increased the risk of allograft failure.The clinical outcomes in patients with biopsy-proven BKVAN were unfavorable in the present study, especially in patients with advanced-stage BKVAN, poor renal function, and acute allograft rejection.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background/aims: BK virus-associated nephropathy (BKVAN) is an important cause of allograft dysfunction in kidney transplant recipients. It has an unfavorable clinical course, and no definite treatment guidelines have yet been established. Here, we report our center's experience with biopsy-proven BKVAN and investigate factors associated with its progression.

Methods: From January 2004 to April 2013, 25 patients with BKVAN were diagnosed by biopsy at Seoul St. Mary's Hospital. Of the 25 patients, 10 were deceaseddonor transplant recipients and 15 were living-donor transplant recipients. Three of the patients underwent retransplantation. The primary immunosuppressant used was tacrolimus in 17 patients and cyclosporine in eight patients.

Results: BKVAN was observed at a mean duration of 22.8 ± 29.1 months after transplantation. The mean serum creatinine level at biopsy was 2.2 ± 0.7 mg/dL. BKVAN occurred with acute rejection in eight patients (28%). Immunosuppression modification was performed in 21 patients (84%). Additionally, leflunomide and intravenous immunoglobulin were administered to 13 patients (52%) and two (8%), respectively. Allograft loss occurred in five patients (27.8%) during the follow- up period at 0.7, 17.1, 21.8, 39.8, and 41.5 months after the BKVAN diagnosis. Advanced stages of BKVAN, increased creatinine levels, and accompanying acute rejection at the time of BKVAN diagnosis increased the risk of allograft failure.

Conclusions: The clinical outcomes in patients with biopsy-proven BKVAN were unfavorable in the present study, especially in patients with advanced-stage BKVAN, poor renal function, and acute allograft rejection.

No MeSH data available.


Related in: MedlinePlus