Key result
Peak PRA >80% linked to ~55% lower BK or CMV infection risk after kidney transplant.
Cohort (n=254)
Hazard Ratio: 0.45 (95% CI 0.23–0.86)
p-value: p=0.02
In kidney transplant recipients with a positive virtual crossmatch, a peak PRA greater than 80% is associated with a lower incidence of CMV and BK infections.
Should not yet guide clinical decisions in sensitized kidney recipients; leaves open whether high PRA modulates BK/CMV risk.
BACKGROUND: There is little information on the incidence, risk factors, and outcomes associated with CMV and BK infections in sensitized patients. METHODS: We examined 254 consecutive kidney transplant recipients with positive virtual crossmatch and negative flow crossmatch. RESULTS: A total of 111 patients (43%) developed CMV disease or BK infection or nephropathy (BKVN). Specifically, 78 patients (30.7%) developed BK infection, 19 (7.5%) had BKVN, and 33 (12.9%) presented with CMV disease. Four patients (1.5%) developed both infections. Mean time from transplant to diagnosis for BK and CMV was 4.07 ± 3.10 and 8.35 ± 5.20 months, respectively. African American (HR, 2.64; 95% CI, 1.37-5.07; P = 0.003), thymoglobulin induction (HR, 2.18; 95% CI, 1.38-3.43; P = 0.0008), DSA greater than 500 MFI at transplant (HR, 1.64; 95% CI, 1.05-2.57; P = 0.03), history of diabetes (HR, 1.62; 95% CI, 1.01-2.60; P = 0.04), CMV D+/R- (HR, 2.30; 95% CI, 1.06-5.01; P = 0.03), and acute rejection (HR, 1.49; 95% CI, 0.99-2.24; P = 0.05) were associated with increase incident of BK/CMV, whereas rituximab (HR, 0.47; 95% CI, 0.24-0.91; P = 0.02), peak PRA greater than 80% (HR, 0.48; 95% CI, 0.27-0.84; P = 0.01), and living donor transplant (HR, 0.57; 95% CI, 0.36-0.87; P = 0.01) were associated with a lower likelihood of infection. Thymoglobulin induction (HR, 2.50; 95% CI, 1.02-6.13; P = 0.04), and peak PRA greater than 80% (HR, 0.45; 95% CI, 0.23-0.86; P = 0.02) remained significant predictors of infection after multivariate adjustment. CONCLUSIONS: Although more than 40% of patients with a positive virtual crossmatch presented with BK infection/CMV disease, high PRA greater than 80% seemed to be protective.
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Parajuli et al. (2016) conducted a cohort in Kidney transplant recipients with positive virtual crossmatch (n=254). Peak PRA greater than 80% vs. Peak PRA 80% or less was evaluated on CMV disease or BK infection or nephropathy (HR 0.45, 95% CI 0.23-0.86, p=0.02). In kidney transplant recipients with a positive virtual crossmatch, peak PRA greater than 80% was associated with a lower risk of BK or CMV infection (HR 0.45; 95% CI 0.23-0.86; P=0.02).
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