Impact of low-level BK polyomavirus viremia on intermediate-term renal allograft function

Abstract

Background

BK polyomavirus (BKPyV)-associated nephropathy (PyVAN) is a significant cause of premature renal transplant failure. High-level BKPyV viremia is predictive for PyVAN, however, low-level BKPyV viremia does not necessarily exclude the presence of PyVAN.

As data are limited whether or not low-level BKPyV viremia has an effect on intermediate-term graft outcome, this study analyzes the impact of low-level BKPyV viremia on intermediate-term graft function and outcome compared to high-level viremia and non-viremic patients.

Methods

All renal transplant patients received follow-up examinations at the Department of Nephrology, University Hospital Essen. Patients were screened for BKPyV viremia and stratified into 3 groups according to their maximum BKPyV load in serum (low-level viremia, high-level viremia, and no viremia).

Results

In 142 of 213 (67%) patients, BKPyV was never detected in serum; 42 of 213 (20%) patients were found positive for low-level viremia (≤10⁴ copies/mL); and 29 of 213 (13%) patients showed high-level viremia with (>10⁴ copies/mL). No significant differences regarding transplant function and graft failure was observed between patients without BKPyV viremia (delta estimate glomerular filtration rate [eGFR] +0.1 mL/min [month 1 vs last visit at month 44]) and patients with low-level BKPyV viremia (delta eGFR -1.7 mL/min). In patients with high-level viremia, transplant function was significantly restricted (delta eGFR -6.5 mL/min) compared to low-level viremia until the last visit at 44 +/- 9.7 months after transplantation. Although the graft function and graft loss was worse in the high-level viremia group compared to no viremia (eGFR 37 vs 45 mL/min) the difference was not significant.

Conclusions

High-level viremia was associated with impaired graft function. In contrast, low-level BKPyV viremia had no significant impact on intermediate-term graft function.

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