Deceased-Donor Acute Kidney Injury and BK Polyomavirus in Kidney Transplant Recipients.
Publication/Presentation Date
5-8-2021
Abstract
BACKGROUND AND OBJECTIVES: 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.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_03_10_CJN18101120_final.mp3.
Volume
16
Issue
5
First Page
765
Last Page
775
ISSN
1555-905X
Published In/Presented At
Hall, I. E., Reese, P. P., Mansour, S. G., Mohan, S., Jia, Y., Thiessen-Philbrook, H. R., Brennan, D. C., Doshi, M. D., Muthukumar, T., Akalin, E., Harhay, M. N., Schröppel, B., Singh, P., Weng, F. L., Bromberg, J. S., & Parikh, C. R. (2021). Deceased-Donor Acute Kidney Injury and BK Polyomavirus in Kidney Transplant Recipients. Clinical journal of the American Society of Nephrology : CJASN, 16(5), 765–775. https://doi.org/10.2215/CJN.18101120
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
33692117
Department(s)
Administration and Leadership
Document Type
Article