Different risk factor profiles distinguish early-onset from late-onset BKV-replication

Transpl Int. 2015 Sep;28(9):1081-91. doi: 10.1111/tri.12601. Epub 2015 May 22.


Two of three reactivations of latent BKV-infection occur within the first 6 months after renal transplantation. However, a clear differentiation between early-onset and late-onset BKV-replication is lacking. Here, we studied all kidney transplant recipients (KTRs) at our single transplant center between 2004 and 2012. A total of 103 of 862 KTRs were diagnosed with BK viremia (11.9%), among which 24 KTRs (2.8%) showed progression to BKV-associated nephropathy (BKVN). Sixty-seven KTRs with early-onset BKV-replication (65%) and 36 KTRs with late-onset BKV-replication (35%) were identified. A control group of 598 KTRs without BKV-replication was used for comparison. Lymphocyte-depleting induction, CMV-reactivation, and acute rejection increased the risk of early-onset BKV-replication (P < 0.05). Presensitized KTRs undergoing renal retransplantation were those at increased risk of late-onset BKV-replication (P < 0.05). Among KTRs with BK viremia, higher doses of mycophenolate increased the risk of progression to BKVN (P = 0.004). KTRs with progression to BKVN showed inferior allograft function (P < 0.05). KTRs with late-onset BK viremia were more likely not to recover to baseline creatinine after BKV-replication (P = 0.018). Our data suggest different risk factors in the pathogenesis of early-onset and late-onset BKV-reactivation. While a more intensified immunosuppression is associated with early-onset BKV-replication, a chronic inflammatory state in presensitized KTRs may contribute to late-onset BKV-replication.

Keywords: BK polyomavirus; CMV; renal transplantation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • BK Virus
  • Creatinine / blood
  • Disease Progression
  • Female
  • Graft Rejection
  • Humans
  • Immunosuppression
  • Immunosuppressive Agents / therapeutic use
  • Inflammation
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Polyomavirus Infections / etiology
  • Renal Insufficiency / complications
  • Renal Insufficiency / surgery*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Virus Replication
  • Young Adult


  • Immunosuppressive Agents
  • Creatinine