ESPN 50th Annual Meeting

ESPN 2017


 
BK VIRAEMIA AND NEPHROPATHY IN PAEDIATRIC RENAL TRANSPLANT RECIPIENTS
Yuko Hamasaki 1 Niamh M Dolan 2 David Cubitt 3 Neil J Sebire 4 Stephen D Marks 2

1- Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
2- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom
3- Department of Virology, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom
4- Department of Pathology, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom
 
Introduction:

 

Patient and allograft survival rates for paediatric renal transplant recipients (pRTR) have improved due to more potent immunosuppressive agents.  However, they are associated with more infectious complications, such as BK viraemia (BKV) which can lead to BK viral associated nephropathy (BKVAN) and progressive renal allograft dysfunction.  We conducted this prospective and longitudinal study to compare incidence of BKV and BKVAN in pRTR.

Material and methods:

 

One hundred and thirty-four pRTR transplanted were included and divided into two groups: Group 1 (15%) were newly transplanted patients and Group 2 (85%) were previous transplanted patients.  Group 1 were prospectively monitored with plasma BKV PCR DNA from the time of transplantation, weekly for the first month, fortnightly for the second and third months, and monthly thereafter.  Group 2 were patients already transplanted and had plasma BKV PCR DNA checked monthly and during episodes of renal allograft dysfunction.

Results:

 

BKV was detected in four (20%) and seven (6%) patients in Group 1 and 2 (with median ages at renal transplantation of 14.2 and 14.1 years in Group 1 and 2), respectively.  Patients who received induction therapy were 75% in Group1 BKV pRTR (vs 43% in Group 2).  The median time to detection of BKV post- transplantation was 44 and 142 days in Group1 and 2, respectively.  BKVAN was diagnosed histologically in three patients (2 and 1 pRTR in Group 1 and 2, respectively) all of whom were receiving tacrolimus, mycophenolate mofetil and corticosteroids as maintenance immunosuppression.  Reduction in BKV PCR DNA was attained in all patients with reducing immunosuppression.

Conclusions:

 

Monitoring of BKV and early intervention to reduce BKVAN are important for pRTR.  The first line of treatment remains careful reduction of immunosuppression and close monitoring of renal allograft function.