Outcomes of renal transplant recipients with BK virus infection and BK virus surveillance in the Auckland region from 2006 to 2012

doi:10.5527/wjn.v5.i6.497

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World Journal of Nephrology

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Retrospective Cohort Study

World J Nephrol. Nov 6, 2016; 5(6): 497-506
Published online Nov 6, 2016. doi: 10.5527/wjn.v5.i6.497

Outcomes of renal transplant recipients with BK virus infection and BK virus surveillance in the Auckland region from 2006 to 2012

Chun-Yuan Hsiao, Helen L Pilmore, Lifeng Zhou, Janak R de Zoysa

Chun-Yuan Hsiao, Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland 1640, New Zealand

Helen L Pilmore, Department of Renal Medicine, Auckland District Health Board, Auckland 1142, New Zealand

Helen L Pilmore, the University of Auckland, Auckland 1010, New Zealand

Lifeng Zhou, Planning, Funding and Outcomes Unit, Waitemata and Auckland District Health Boards, Auckland 0740, New Zealand

Janak R de Zoysa, Department of Renal Medicine, North Shore Hospital, Waitemata District Health Board, Auckland 0740, New Zealand

Janak R de Zoysa, Waitemata Clinical School, the University of Auckland, Auckland 0740, New Zealand

Author contributions: Hsiao CY performed the study design, data collection and analysis, statistics and writing of the manuscript; Pilmore HL performed study design, assistance in performing the study and revision of the manuscript; Zhou L provided advice on biostatistics and revision of the manuscript; de Zoysa JR performed study design, assistance in performing the study and revision of the manuscript.

Institutional review board statement: This retrospective review was approved by the Northern X Regional Ethics Committee (NTX/EXP).

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous, de-identified clinical data.

Conflict-of-interest statement: There are no conflicts of interest in the publication of this paper.

Data sharing statement: The original de-identified dataset is available on request from the corresponding author at chunyuan.hsiao@middlemore.co.nz.

Correspondence to: Chun-Yuan Hsiao, FRACP, Physician and Nephrologist, Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand. chunyuan.hsiao@middlemore.co.nz

Telephone: +64-9-2760000

Received: May 25, 2016
Peer-review started: May 26, 2016
First decision: June 17, 2016
Revised: August 8, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: November 6, 2016
Processing time: 161 Days and 19 Hours

Abstract

AIM

To evaluate incidence, risk factors and treatment outcome of BK polyomavirus nephropathy (BKVN) in a cohort of renal transplant recipients in the Auckland region without a formal BK polyomavirus (BKV) surveillance programme.

METHODS

A cohort of 226 patients who received their renal transplants from 2006 to 2012 was retrospectively reviewed.

RESULTS

Seventy-six recipients (33.6%) had a BK viral load (BKVL) test and 9 patients (3.9%) developed BKVN. Cold ischaemia time (HR = 1.18, 95%CI: 1.04-1.35) was found to be a risk factor for BKVN. Four recipients with BKVN had complete resolution of their BKV infection; 1 recipient had BKVL less than 625 copies/mL; 3 recipients had BKVL more than 1000 copies/mL and 1 had graft failure from BKVN. BKVN has a negative impact on graft function [median estimated glomerular filtration rate (eGFR) 22.5 (IQR 18.5-53.0) mL/min per 1.73 m², P = 0.015), but no statistically significant difference (P = 0.374) in renal allograft function was found among negative BK viraemia group [median eGFR 60.0 (IQR 48.5-74.2) mL/min per 1.73 m²), positive BK viraemia without BKVN group [median eGFR 55.0 (IQR 47.0-76.0) mL/min per 1.73 m²] and unknown BKV status group [median eGFR 54.0 (IQR 43.8-71.0) mL/min per 1.73 m²]. The incidence and treatment outcomes of BKVN were similar to some centres with BKV surveillance programmes.

CONCLUSION

Recipients with BVKN have poorer graft function. Although active surveillance for BKV has been shown to be effective in reducing incidence of BKVN, it should be tailored specifically to that transplant centre based on its epidemiology and outcomes of BKVN, particularly in centres with limited resources.

Keywords: BK virus; BK polyomavirus nephropathy; Kidney transplantation; Screening

Core tip: A retrospective analysis of 226 patients from Auckland, New Zealand found BK polyomavirus (BKV) as an uncommon cause of graft loss. Renal units without a formal BKV surveillance programme showed a similar incidence and outcomes for BK polyomavirus nephropathy (BKVN) to centres with an active screening programme. When designing a cost effective screening programme for BKV infection, it should be centre specific in relation to the units immunosuppression and monitoring protocol, epidemiology and outcomes of BKVN.