ABSTRACT Background BK viremia is associated with worse kidney transplant function and de novo donor‐specific antibodies (DSA), but mortality and graft survival are not impacted in the short‐ and intermediate‐term. The long‐term impact of BK viremia remains unclear. Methods We performed a single‐center retrospective study on 1058 consecutive kidney or kidney‐pancreas transplant recipients. We classified the cohort based on the presence or absence of BK viremia, BK viral loads, persistence of BK viremia, and pre‐existing or de novo DSA. Outcomes included mortality, graft loss, death‐censored graft survival (DCGS), estimated glomerular filtration rate, biopsy‐proven acute rejection (BPAR), de novo DSA, ureteral stenosis, and genitourinary (GU) malignancies. Results Over a median follow‐up period of 9.7 years, there was no difference in graft loss ( p = 0.08) and mortality ( p = 0.56). Time‐varying multivariable analysis showed no difference in DCGS HR 1.02, (0.91–1.16). Compared to never BK viremic patients, patients with BK viremia had similar graft function at 5 and 10 years ( p = 0.09 and 0.65, respectively), rates of GU malignancies (7.0% vs. 5.2%, p = 0.35) and ureteral stenosis (0.8% vs. 0.4%, p = 0.63). Patients with BK viral loads >10 000 copies/mL had a higher risk of de novo DSA HR 1.71, (1.08–2.68) and BPAR HR 2.11, (1.28–3.47). Conclusions BK viremia did not impact mortality, graft loss, kidney function, GU malignancies, and ureteral stenosis over long‐term follow‐up, but BPAR episodes and development of de novo DSA were higher with viral loads >10 000 copies/mL. Strict monitoring protocols and immunosuppression reduction strategies are effective in minimizing the risk associated with BK viremia.
Tandukar et al. (Wed,) studied this question.
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