Evaluation of BK Polyomavirus Monitoring and Management in Kidney Transplant Recipients
Tomeczkowicz M, Mondal S, Sulejmani N, Summers B, Larson T, and Jantz A. Evaluation of BK Polyomavirus Monitoring and Management in Kidney Transplant Recipients. Am J Transplant 2019; 19:986.
Am J Transplant
Purpose: BK polyomavirus (BKV) is an opportunistic infection that can lead to BKV nephropathy and premature graftloss within the first year post-transplant. The mainstay oftherapy is early detection and reduction ofimmunosuppression, but BKV management is not standardized. Guidelines were institutedat our centerto streamline management of BKV in kidney transplant recipients. The purpose of this analysis is to assess the monitoring and outcomes of BKV in kidney transplant recipients. Methods: This is a single-center, retrospective study evaluating the management of BKV in kidney transplant recipients transplanted between July 2017 and June 2018. Patients were excluded if they were a multi-organ transplant or were receiv-ing cyclosporine or sirolimus post-transplant. The primary outcome was to assess adherence toBKV monitoring post-transplant per center-specific guidelines. Adher-ence was defined as BKV PCR drawn at time points specified in guideline ± 7 days. Secondary outcomes included evaluation of BKV treatment in those diagnosed with BKviremia and patient outcomes. Results: A total of 71 patients were included in the study. Twelve patients met the criteria for BKV treatment and none of the patients had prior history of BKV. The primary outcome of the study revealed the following rate of compliance to our center's BKV monitoring guideline: 45% at 1 month post-transplant, 23% between 1 to 6 months, 7% between 6 to 9 months, and 74% at 12 months. In regards to treatment, 6 of the 12 patients (50%) were appropriately treated per center-specific guidelines. Of the patients managed appropriately, four patients achieved BKV clearance to PCR <1000 IU/mL and one patient reached an undetectable load of BKV PCR. In those who were not treated appropriately, two patients had modifications of their immunosuppression not according to guideline. Both of these patients were diagnosed with biopsy proven rejection and did not have resolution of their BKV. The remaining four patients did not receive treatment and did not achieve clearance of BKV. Patient and graft survival of the group receiving treatment was 100% at the end of follow-up.