Introduction:
Though kidney transplant is the best modality of treatment for End-Stage-Renal Disease, it is complicated by infections like BK Polyoma Virus which subsequently leads to BK Polyoma virus Nephropathy and graft loss. Early recognition of BK virus nephropathy and reduction of immunosuppressants can diminish risk of graft loss. There is lack of clinical data regarding BK Polyoma virus Nephropathy and its outcome in developing countries like Nepal.
The aim of this study was to evaluate the clinical characteristics and outcome of BK Polyoma virus Nephropathy among kidney transplant recipients.
Methods:
A retrospective study was done in tertiary level transplant center in Nepal in September 2024. The medical records of living-donor transplant recipients with biopsy proven BK virus Nephropathy from August 2008 to April 2024 were included and the records were followed. Date of transplant, recipient age, recipient sex, donor age, donor sex, relationship with Donor, Blood group compatibility, induction agent and immunosuppressive used at the time of BKN diagnosis, co-morbid diabetes, other infections during the time of diagnosis, changes in maintenance immunosuppression, other treatments received, renal function 1 year after diagnosis and need for dialysis were studied.
Results:
Out of 847 living-donor kidney transplant performed in the study period, 15 (1.77%) had biopsy proven BK Nephropathy. Of them, 13 (86.7%) were male and the mean age of recipient was 42 ± 11.533 years and 5 (33.33%) were diabetic. Most of the donor were female (14, 93.3%) and the average age at donation was 44.27 ± 8.396 years. The recipients were related by blood in 6 cases (40.2%) and the average HLA mismatch was 3/6. BK Virus Nephropathy was diagnosed after a mean period of 16.07±13.24 months after transplant. The induction agent used was Thymoglobulin in 11 cases (73.3%), Basiliximab in 1 (6.67%), Grafalon in 2 (13.33%) and no induction agent was used in 1 (6.67%). All of the patients were on Tacrolimus, Mycophenolate mofetil and Prednisolone at the time of diagnosis. The average 24-hour-Tacrolimus dose was 3.321mg ± 2.47mg, mycophenolate mofetil was 1392.86 ± 212.91mg and that of prednisolone was 5mg. The average creatinine at diagnosis was 147.93 ± 40.882 umol/L.
Following diagnosis, all of the patients underwent reduction in immunosuppressive drugs. The new 24-hour-dose of tacrolimus was 2.28 ± 1.29 mg, mycophenolate mofetil was 660.71 ± 374.77mg while prednisolone dose was unchanged at 5mg. One patient was treated with IVIG while 11 (73.3%) were treated with fluoroquinolone antibiotic.
Average creatinine after 1 year of diagnosis was 164.43 ± 101.03 umol/L. Of the 15 patients, 1 patient required maintenance hemodialysis 3 years after diagnosis. She was a case of neurogenic bladder with history of recurrent urinary tract infection.
Conclusions:
In this study, the prevalence of BK virus Nephropathy and subsequent return to dialysis was found to be low in our population. Patients were treated with reduction in immunosuppressive medications and fluoroquinolone in majority of cases.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.