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BK virus is not a significant cause of graft loss in HIV+ kidney recipients (oral presentation)


Conference Paper

Blumberg, E.; Barin, B.; Bloom, R.; Roland, M.; Olsen, J.; Murphy, B.; Pavlakis, M.; Roth, D.; Moore, J.; Cangro, C.; Saltzberg, S.; Fine, D.; Josephson, M.; Guasch, A.; Lobo, P.; Zhang, R.; Gallon, L.; Gonin, J.; Fatica, R.; Mogilshetty, G.; Stock, P.

Philadelphia, PA


Graft function; HIV virus; kidney transplantation; Polyma virus

BK virus infection (BKV) is a significant cause of allograft damage and loss in kidney recipients (KR). Whether BKV affects HIV+ KR outcomes is unknown. We evaluated the impact of BK on HIV+ KR. Methods: 159 KR (9 combined with liver transplants) were evaluated as part of a multicenter transplant trial in HIV+ KR. The following risk factors for BKV were evaluated in proportional hazards (PH) models: age, gender, race, nadir and baseline CD4, HCV co-infection, anti IL2R induction, thymoglobulin induction, initial calcineurin inhibitor, opportunistic infection history, donor source and age, and ECD as baseline factors, and rejection as a time-dependent covariate. Results: 20 KR (13%) had BKV infection (10 BK nephropathy by biopsy, 2 viruria alone, 8 viremia alone). Median time to BKV detection was 220 days post tx (range 42-976 days). 13 pts (9 with nephropathy) were treated with reduction of immunosuppression, 6 received antivirals (2 cidofovir, 3 leflunomide, 1 both). 14 resolved infection after median of approx 110 days (range 14-487). 5 KR (3 with nephropathy) experienced graft loss, 1 due to BK, 3 to rejection, and 1 to recurrent disease. In the remaining 15, median creatinine at last measurement was 1.6 mg/dL (range 0.8-4.7 mg/dL); in KR with BK nephropathy, median creatinine at last measurement was 1.9 mg/dL(range 1.4-3.4 mg/dL). In multivariate PH model, rejection (HR: 4.53; p=0.001) and anti IL2R induction (HR: 2.44; p=0.06) were significantly and marginally associated with increased risk of BKV. BKV infection was not significantly associated with either increased risk of rejection (HR: 2.01; p=0.25) or graft loss (HR 1.39; p=0.49) in univariate PH models. Conclusions: BKV infection prevalence in HIV+ KR is not higher than reported in HIV uninfected KR and was not a significant risk factor for graft loss.Keywords: HIV virus; Polyma virus; Kidney transplantation; Graft function

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