Association of BK viremia with human leukocyte antigen mismatches and acute rejection, but not with type of calcineurin inhibitor
Introduction BK viremia and polyomavirus‐associated nephropathy (PVN) represent a significant problem after kidney transplantation. Both are associated with intensified immunosuppression, but other risk factors and the impact of a screening program on outcome are incompletely understood. Methods Her...
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| Veröffentlicht in: | Transplant infectious disease 2014-02, Vol.16 (1), p.44-54 |
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| creator | Hässig, A. Roos, M. Etter, A. Bossart, W. Müller, N. Schiesser, M. Wüthrich, R.P. Fehr, T. |
| description | Introduction
BK viremia and polyomavirus‐associated nephropathy (PVN) represent a significant problem after kidney transplantation. Both are associated with intensified immunosuppression, but other risk factors and the impact of a screening program on outcome are incompletely understood.
Methods
Here, we report on the short‐ and long‐term outcome of a cohort of patients, who were transplanted in 2006/2007 and included in a newly introduced systematic 3‐monthly screening for BK viremia at the University Hospital Zurich. In patients testing positive for BK viremia, screening frequency was intensified and immunosuppression reduced. Patients with suspected PVN underwent transplant biopsy.
Results
Among 152 included patients, 49 (32%) tested positive for BK viremia, but only 8 developed biopsy‐proven PVN. BK viremia had a significant impact on estimated glomerular filtration rate and proteinuria in the first 2 years. Acute rejection episodes and the number of human leukocyte antigen (HLA) mismatches were the strongest independent predictors of BK viremia in a multiple logistic model. In contrast, no particular immunosuppressive agent or regimen was associated with enhanced risk.
Conclusion
Taken together, systematic BK viremia screening led to detection of a high percentage of viremic patients. With adjustment of immunosuppression, an excellent outcome was achieved. The independent association of HLA mismatches with BK viremia suggests impaired polyomavirus immunosurveillance in highly mismatched allografts. |
| doi_str_mv | 10.1111/tid.12153 |
| format | Article |
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BK viremia and polyomavirus‐associated nephropathy (PVN) represent a significant problem after kidney transplantation. Both are associated with intensified immunosuppression, but other risk factors and the impact of a screening program on outcome are incompletely understood.
Methods
Here, we report on the short‐ and long‐term outcome of a cohort of patients, who were transplanted in 2006/2007 and included in a newly introduced systematic 3‐monthly screening for BK viremia at the University Hospital Zurich. In patients testing positive for BK viremia, screening frequency was intensified and immunosuppression reduced. Patients with suspected PVN underwent transplant biopsy.
Results
Among 152 included patients, 49 (32%) tested positive for BK viremia, but only 8 developed biopsy‐proven PVN. BK viremia had a significant impact on estimated glomerular filtration rate and proteinuria in the first 2 years. Acute rejection episodes and the number of human leukocyte antigen (HLA) mismatches were the strongest independent predictors of BK viremia in a multiple logistic model. In contrast, no particular immunosuppressive agent or regimen was associated with enhanced risk.
Conclusion
Taken together, systematic BK viremia screening led to detection of a high percentage of viremic patients. With adjustment of immunosuppression, an excellent outcome was achieved. The independent association of HLA mismatches with BK viremia suggests impaired polyomavirus immunosurveillance in highly mismatched allografts.</description><identifier>ISSN: 1398-2273</identifier><identifier>EISSN: 1399-3062</identifier><identifier>DOI: 10.1111/tid.12153</identifier><identifier>PMID: 24134704</identifier><language>eng</language><publisher>Denmark: Blackwell Publishing Ltd</publisher><subject>acute rejection ; Adult ; Aged ; Allografts - immunology ; Antibodies, Monoclonal - therapeutic use ; Azathioprine - therapeutic use ; BK nephropathy ; BK Virus ; Cohort Studies ; Cyclosporine - therapeutic use ; Female ; Glomerular Filtration Rate ; Graft Rejection - immunology ; Graft Rejection - prevention & control ; Histocompatibility - immunology ; HLA Antigens - immunology ; HLA matching ; Humans ; immunosuppression ; Immunosuppressive Agents - therapeutic use ; Kidney Diseases - immunology ; Kidney Diseases - virology ; Kidney Transplantation ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Mycophenolic Acid - analogs & derivatives ; Mycophenolic Acid - therapeutic use ; Polyomavirus Infections - immunology ; polyomavirus-associated nephropathy ; Proteinuria - immunology ; Pyrroles - therapeutic use ; Quinazolines - therapeutic use ; Recombinant Fusion Proteins - therapeutic use ; Tacrolimus - therapeutic use ; Tumor Virus Infections - immunology ; Viremia - immunology</subject><ispartof>Transplant infectious disease, 2014-02, Vol.16 (1), p.44-54</ispartof><rights>2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>2014 Wiley Periodicals, Inc</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3913-7dcba7a4fae3a3fa33aff3a73b5c85a655b6c97304062268729772ec98645e1c3</citedby><cites>FETCH-LOGICAL-c3913-7dcba7a4fae3a3fa33aff3a73b5c85a655b6c97304062268729772ec98645e1c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftid.12153$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftid.12153$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24134704$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hässig, A.</creatorcontrib><creatorcontrib>Roos, M.</creatorcontrib><creatorcontrib>Etter, A.</creatorcontrib><creatorcontrib>Bossart, W.</creatorcontrib><creatorcontrib>Müller, N.</creatorcontrib><creatorcontrib>Schiesser, M.</creatorcontrib><creatorcontrib>Wüthrich, R.P.</creatorcontrib><creatorcontrib>Fehr, T.</creatorcontrib><title>Association of BK viremia with human leukocyte antigen mismatches and acute rejection, but not with type of calcineurin inhibitor</title><title>Transplant infectious disease</title><addtitle>Transpl Infect Dis</addtitle><description>Introduction
BK viremia and polyomavirus‐associated nephropathy (PVN) represent a significant problem after kidney transplantation. Both are associated with intensified immunosuppression, but other risk factors and the impact of a screening program on outcome are incompletely understood.
Methods
Here, we report on the short‐ and long‐term outcome of a cohort of patients, who were transplanted in 2006/2007 and included in a newly introduced systematic 3‐monthly screening for BK viremia at the University Hospital Zurich. In patients testing positive for BK viremia, screening frequency was intensified and immunosuppression reduced. Patients with suspected PVN underwent transplant biopsy.
Results
Among 152 included patients, 49 (32%) tested positive for BK viremia, but only 8 developed biopsy‐proven PVN. BK viremia had a significant impact on estimated glomerular filtration rate and proteinuria in the first 2 years. Acute rejection episodes and the number of human leukocyte antigen (HLA) mismatches were the strongest independent predictors of BK viremia in a multiple logistic model. In contrast, no particular immunosuppressive agent or regimen was associated with enhanced risk.
Conclusion
Taken together, systematic BK viremia screening led to detection of a high percentage of viremic patients. With adjustment of immunosuppression, an excellent outcome was achieved. The independent association of HLA mismatches with BK viremia suggests impaired polyomavirus immunosurveillance in highly mismatched allografts.</description><subject>acute rejection</subject><subject>Adult</subject><subject>Aged</subject><subject>Allografts - immunology</subject><subject>Antibodies, Monoclonal - therapeutic use</subject><subject>Azathioprine - therapeutic use</subject><subject>BK nephropathy</subject><subject>BK Virus</subject><subject>Cohort Studies</subject><subject>Cyclosporine - therapeutic use</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Graft Rejection - immunology</subject><subject>Graft Rejection - prevention & control</subject><subject>Histocompatibility - immunology</subject><subject>HLA Antigens - immunology</subject><subject>HLA matching</subject><subject>Humans</subject><subject>immunosuppression</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kidney Diseases - immunology</subject><subject>Kidney Diseases - virology</subject><subject>Kidney Transplantation</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Mycophenolic Acid - analogs & derivatives</subject><subject>Mycophenolic Acid - therapeutic use</subject><subject>Polyomavirus Infections - immunology</subject><subject>polyomavirus-associated nephropathy</subject><subject>Proteinuria - immunology</subject><subject>Pyrroles - therapeutic use</subject><subject>Quinazolines - therapeutic use</subject><subject>Recombinant Fusion Proteins - therapeutic use</subject><subject>Tacrolimus - therapeutic use</subject><subject>Tumor Virus Infections - immunology</subject><subject>Viremia - immunology</subject><issn>1398-2273</issn><issn>1399-3062</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1v1DAQhiMEoh9w4A8gS1xAIm2cSeL1sS2wLaxAQkVIXKyJd8J6m9iL7bTskX-Ot2l7QMIXW_Yzz3j0ZtkLXhzxtI6jWR7xktfwKNvnIGUORVM-vj3P8rIUsJcdhLAuCi5kJZ9me2XFoRJFtZ_9OQnBaYPROMtcx04_sWvjaTDIbkxcsdU4oGU9jVdObyMxtNH8JMsGEwaMekUhXS0Z6jE9elqT3pnesnaMzLo4SeJ2Qzu5xl4bS6M3lhm7Mq2Jzj_LnnTYB3p-tx9m3z68vzw7zxdf5hdnJ4tcg-SQi6VuUWDVIQFChwDYdYAC2lrPamzqum20FFBUafaymYlSClGSlrOmqolrOMxeT96Nd79GClGlGTT1PVpyY1C8kqmPLAtI6Kt_0LUbvU2_21ECkrGpEvVmorR3IXjq1MabAf1W8ULtclEpF3WbS2Jf3hnHdqDlA3kfRAKOJ-DG9LT9v0ldXry7V-ZThQmRfj9UoL9SjQBRq--f5-rrx_OZXMwb9QP-AhEdpxs</recordid><startdate>201402</startdate><enddate>201402</enddate><creator>Hässig, A.</creator><creator>Roos, M.</creator><creator>Etter, A.</creator><creator>Bossart, W.</creator><creator>Müller, N.</creator><creator>Schiesser, M.</creator><creator>Wüthrich, R.P.</creator><creator>Fehr, T.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201402</creationdate><title>Association of BK viremia with human leukocyte antigen mismatches and acute rejection, but not with type of calcineurin inhibitor</title><author>Hässig, A. ; Roos, M. ; Etter, A. ; Bossart, W. ; Müller, N. ; Schiesser, M. ; Wüthrich, R.P. ; Fehr, T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3913-7dcba7a4fae3a3fa33aff3a73b5c85a655b6c97304062268729772ec98645e1c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>acute rejection</topic><topic>Adult</topic><topic>Aged</topic><topic>Allografts - immunology</topic><topic>Antibodies, Monoclonal - therapeutic use</topic><topic>Azathioprine - therapeutic use</topic><topic>BK nephropathy</topic><topic>BK Virus</topic><topic>Cohort Studies</topic><topic>Cyclosporine - therapeutic use</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Graft Rejection - immunology</topic><topic>Graft Rejection - prevention & control</topic><topic>Histocompatibility - immunology</topic><topic>HLA Antigens - immunology</topic><topic>HLA matching</topic><topic>Humans</topic><topic>immunosuppression</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kidney Diseases - immunology</topic><topic>Kidney Diseases - virology</topic><topic>Kidney Transplantation</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Mycophenolic Acid - analogs & derivatives</topic><topic>Mycophenolic Acid - therapeutic use</topic><topic>Polyomavirus Infections - immunology</topic><topic>polyomavirus-associated nephropathy</topic><topic>Proteinuria - immunology</topic><topic>Pyrroles - therapeutic use</topic><topic>Quinazolines - therapeutic use</topic><topic>Recombinant Fusion Proteins - therapeutic use</topic><topic>Tacrolimus - therapeutic use</topic><topic>Tumor Virus Infections - immunology</topic><topic>Viremia - immunology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hässig, A.</creatorcontrib><creatorcontrib>Roos, M.</creatorcontrib><creatorcontrib>Etter, A.</creatorcontrib><creatorcontrib>Bossart, W.</creatorcontrib><creatorcontrib>Müller, N.</creatorcontrib><creatorcontrib>Schiesser, M.</creatorcontrib><creatorcontrib>Wüthrich, R.P.</creatorcontrib><creatorcontrib>Fehr, T.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transplant infectious disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hässig, A.</au><au>Roos, M.</au><au>Etter, A.</au><au>Bossart, W.</au><au>Müller, N.</au><au>Schiesser, M.</au><au>Wüthrich, R.P.</au><au>Fehr, T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of BK viremia with human leukocyte antigen mismatches and acute rejection, but not with type of calcineurin inhibitor</atitle><jtitle>Transplant infectious disease</jtitle><addtitle>Transpl Infect Dis</addtitle><date>2014-02</date><risdate>2014</risdate><volume>16</volume><issue>1</issue><spage>44</spage><epage>54</epage><pages>44-54</pages><issn>1398-2273</issn><eissn>1399-3062</eissn><abstract>Introduction
BK viremia and polyomavirus‐associated nephropathy (PVN) represent a significant problem after kidney transplantation. Both are associated with intensified immunosuppression, but other risk factors and the impact of a screening program on outcome are incompletely understood.
Methods
Here, we report on the short‐ and long‐term outcome of a cohort of patients, who were transplanted in 2006/2007 and included in a newly introduced systematic 3‐monthly screening for BK viremia at the University Hospital Zurich. In patients testing positive for BK viremia, screening frequency was intensified and immunosuppression reduced. Patients with suspected PVN underwent transplant biopsy.
Results
Among 152 included patients, 49 (32%) tested positive for BK viremia, but only 8 developed biopsy‐proven PVN. BK viremia had a significant impact on estimated glomerular filtration rate and proteinuria in the first 2 years. Acute rejection episodes and the number of human leukocyte antigen (HLA) mismatches were the strongest independent predictors of BK viremia in a multiple logistic model. In contrast, no particular immunosuppressive agent or regimen was associated with enhanced risk.
Conclusion
Taken together, systematic BK viremia screening led to detection of a high percentage of viremic patients. With adjustment of immunosuppression, an excellent outcome was achieved. The independent association of HLA mismatches with BK viremia suggests impaired polyomavirus immunosurveillance in highly mismatched allografts.</abstract><cop>Denmark</cop><pub>Blackwell Publishing Ltd</pub><pmid>24134704</pmid><doi>10.1111/tid.12153</doi><tpages>11</tpages></addata></record> |
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| subjects | acute rejection Adult Aged Allografts - immunology Antibodies, Monoclonal - therapeutic use Azathioprine - therapeutic use BK nephropathy BK Virus Cohort Studies Cyclosporine - therapeutic use Female Glomerular Filtration Rate Graft Rejection - immunology Graft Rejection - prevention & control Histocompatibility - immunology HLA Antigens - immunology HLA matching Humans immunosuppression Immunosuppressive Agents - therapeutic use Kidney Diseases - immunology Kidney Diseases - virology Kidney Transplantation Logistic Models Male Middle Aged Multivariate Analysis Mycophenolic Acid - analogs & derivatives Mycophenolic Acid - therapeutic use Polyomavirus Infections - immunology polyomavirus-associated nephropathy Proteinuria - immunology Pyrroles - therapeutic use Quinazolines - therapeutic use Recombinant Fusion Proteins - therapeutic use Tacrolimus - therapeutic use Tumor Virus Infections - immunology Viremia - immunology |
| title | Association of BK viremia with human leukocyte antigen mismatches and acute rejection, but not with type of calcineurin inhibitor |
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