Deceased-Donor Acute Kidney Injury and BK Polyomavirus in Kidney Transplant Recipients

BK polyomavirus (BKV) infection commonly complicates kidney transplantation, contributing to morbidity and allograft failure. The virus is often donor-derived and influenced by ischemia-reperfusion processes and disruption of structural allograft integrity. We hypothesized that deceased-donor AKI as...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2021-05, Vol.16 (5), p.765-775
Main Authors: Hall, Isaac E, Reese, Peter Philip, Mansour, Sherry G, Mohan, Sumit, Jia, Yaqi, Thiessen-Philbrook, Heather R, Brennan, Daniel C, Doshi, Mona D, Muthukumar, Thangamani, Akalin, Enver, Harhay, Meera Nair, Schröppel, Bernd, Singh, Pooja, Weng, Francis L, Bromberg, Jonathan S, Parikh, Chirag R
Format: Article
Language:English
Subjects:
Acute Kidney Injury
Adult
Aged
BK Virus
Cadaver
Female
Humans
Kidney Transplantation
Male
Middle Aged
Original
Polyomavirus Infections - epidemiology
Polyomavirus Infections - etiology
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Prospective Studies
Tissue and Organ Procurement
Tumor Virus Infections - epidemiology
Tumor Virus Infections - etiology
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Summary:BK polyomavirus (BKV) infection commonly complicates kidney transplantation, contributing to morbidity and allograft failure. The virus is often donor-derived and influenced by ischemia-reperfusion processes and disruption of structural allograft integrity. We hypothesized that deceased-donor AKI associates with BKV infection in recipients. We studied 1025 kidney recipients from 801 deceased donors transplanted between 2010 and 2013, at 13 academic centers. We fitted Cox proportional-hazards models for BKV DNAemia (detectable in recipient blood by clinical PCR testing) within 1 year post-transplantation, adjusting for donor AKI and other donor- and recipient-related factors. We validated findings from this prospective cohort with analyses for graft failure attributed to BKV within the Organ Procurement and Transplantation Network (OPTN) database. The multicenter cohort mean kidney donor profile index was 49±27%, and 26% of donors had AKI. Mean recipient age was 54±13 years, and 25% developed BKV DNAemia. Donor AKI was associated with lower risk for BKV DNAemia (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79). In the OPTN database, 22,537 (25%) patients received donor AKI kidneys, and 272 (0.3%) developed graft failure from BKV. The adjusted hazard ratio for the outcome with donor AKI was 0.7 (95% confidence interval, 0.52 to 0.95). In a well-characterized, multicenter cohort, contrary to our hypothesis, deceased-donor AKI independently associated with lower risk for BKV DNAemia. Within the OPTN database, donor AKI was also associated with lower risk for graft failure attributed to BKV. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_03_10_CJN18101120_final.mp3.
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.18101120