Outcomes of kidney retransplantation after graft loss as a result of BK virus nephropathy in the era of newer immunosuppressant agents

Am J Transplant. 2020 May;20(5):1334-1340. doi: 10.1111/ajt.15723. Epub 2019 Dec 24.

Abstract

We conducted this study using the updated 2005-2016 Organ Procurement and Transplantation Network database to assess clinical outcomes of retransplant after allograft loss as a result of BK virus-associated nephropathy (BKVAN). Three hundred forty-one patients had first graft failure as a result of BKVAN, whereas 13 260 had first graft failure as a result of other causes. At median follow-up time of 4.70 years after the second kidney transplant, death-censored graft survival at 5 years for the second renal allograft was 90.6% for the BK group and 83.9% for the non-BK group. In adjusted analysis, there was no difference in death-censored graft survival (P = .11), acute rejection (P = .49), and patient survival (P = .13) between the 2 groups. When we further compared death-censored graft survival among the specific causes for first graft failure, the BK group had better graft survival than patients who had prior allograft failure as a result of acute rejection (P < .001) or disease recurrence (P = .003), but survival was similar to those with chronic allograft nephropathy (P = .06) and other causes (P = .05). The better allograft survival in the BK group over acute rejection and disease recurrence remained after adjusting for potential confounders. History of allograft loss as a result of BKVAN should not be a contraindication to retransplant among candidates who are otherwise acceptable.

Keywords: clinical research/practice; complication; infectious disease; kidney transplantation/nephrology.

MeSH terms

  • BK Virus*
  • Graft Rejection / etiology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney
  • Kidney Transplantation* / adverse effects
  • Polyomavirus Infections* / etiology
  • Reoperation
  • Tumor Virus Infections* / etiology

Substances

  • Immunosuppressive Agents