De novo donor-specific antibody following BK nephropathy: The incidence and association with antibody-mediated rejection

Clin Transplant. 2018 Mar;32(3):e13194. doi: 10.1111/ctr.13194. Epub 2018 Feb 11.

Abstract

Background and objectives: The risk of de novo donor-specific antibody (dnDSA) development following BK viremia (BKV) or nephropathy (BKN) after kidney transplant remains unclear. We aimed to evaluate the relationships among dnDSA, BKV (BK blood PCR > 15 000 copies), BKN, antibody-mediated rejection (AMR), and allograft loss.

Patients and methods: We performed a retrospective cohort study of 904 solitary kidney transplant recipients transplanted between 10/2007 and 5/2014. Cox proportional hazards regression with time-dependent covariates were used to assess the relationships among BKN, isolated BKV, dnDSA, and the subsequent risk of AMR and allograft loss.

Results: In multivariate analysis, we observed that BKN, but not BKV was a risk factor for dnDSA (HR, 3.18, P = .008). Of the patients with BK nephropathy, 14.0% (6/43) developed dnDSA, which occurred within 14 months of BK diagnosis. DnDSA in this setting remains a risk factor for subsequent AMR (HR 4.75, P = .0001) and allograft loss (HR 2.63, P = .018).

Conclusions: BKN is an independent risk factor for development of dnDSA. Improved understanding of the characteristics of patients with BKN who are at highest risk for development of dnDSA would be valuable to customize immunosuppression reduction in this population.

Keywords: BK nephropathy; antibody-mediated rejection; donor-specific antibody; immunosuppression; kidney transplantation; polyomavirus.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • BK Virus / isolation & purification
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Rejection / epidemiology*
  • Graft Rejection / etiology
  • Graft Rejection / pathology
  • Graft Survival
  • Humans
  • Incidence
  • Isoantibodies / adverse effects*
  • Kidney Diseases / virology*
  • Kidney Function Tests
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Minnesota / epidemiology
  • Polyomavirus Infections / complications*
  • Polyomavirus Infections / virology
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Tissue Donors*
  • Tumor Virus Infections / complications*
  • Tumor Virus Infections / virology

Substances

  • Isoantibodies