HLA mismatching increases the risk of BK virus nephropathy in renal transplant recipients

Am J Transplant. 2004 Oct;4(10):1691-6. doi: 10.1111/j.1600-6143.2004.00563.x.


BK virus (BKV) nephropathy is a serious complication in kidney transplant recipients that may lead to irreversible graft failure. We have analyzed the degree of donor/recipient HLA compatibility and HLA antigen association in 40 kidney transplant patients with BKV nephropathy in comparison with a control group of 404 unaffected transplant recipients who were on tacrolimus-based immunosuppression with no induction. HLA compatibility was assessed by determining the number of HLA-A, -B, -DR-mismatched antigens. BK virus nephropathy was diagnosed histologically and confirmed by immunochemistry. Univariate and multiple logistic regression statistical analyses have shown a significant association between BKV nephropathy and HLA mismatching. This analysis showed also that BKV nephritis is associated with a greater number of rejection episodes and a higher incidence of steroid-resistant rejection requiring antilymphocyte treatment. There was no association between BKV nephropathy and any specific HLA allele. We propose that HLA mismatching promotes the development of BKV nephropathy through rejection-related inflammatory processes and heavy immunosuppression which cause virus reactivation and injury of the tubular epithelium.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • BK Virus / immunology*
  • Female
  • HLA Antigens / immunology*
  • Humans
  • Kidney / immunology
  • Kidney / virology*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Polyomavirus Infections / immunology*
  • Tacrolimus / blood
  • Tumor Virus Infections / immunology*


  • HLA Antigens
  • Tacrolimus