De novo donor-specific antibody following BK nephropathy: The incidence and association with antibody-mediated rejection.

Abstract:

BACKGROUND AND OBJECTIVES:The risk of de novo donor-specific antibody (dnDSA) development following BK viremia (BKV) or nephropathy (BKN) after kidney transplant remains unclear. We aimed to evaluate the relationships among dnDSA, BKV (BK blood PCR > 15 000 copies), BKN, antibody-mediated rejection (AMR), and allograft loss. PATIENTS AND METHODS:We performed a retrospective cohort study of 904 solitary kidney transplant recipients transplanted between 10/2007 and 5/2014. Cox proportional hazards regression with time-dependent covariates were used to assess the relationships among BKN, isolated BKV, dnDSA, and the subsequent risk of AMR and allograft loss. RESULTS:In multivariate analysis, we observed that BKN, but not BKV was a risk factor for dnDSA (HR, 3.18, P = .008). Of the patients with BK nephropathy, 14.0% (6/43) developed dnDSA, which occurred within 14 months of BK diagnosis. DnDSA in this setting remains a risk factor for subsequent AMR (HR 4.75, P = .0001) and allograft loss (HR 2.63, P = .018). CONCLUSIONS:BKN is an independent risk factor for development of dnDSA. Improved understanding of the characteristics of patients with BKN who are at highest risk for development of dnDSA would be valuable to customize immunosuppression reduction in this population.

journal_name

Clin Transplant

journal_title

Clinical transplantation

authors

Cheungpasitporn W,Kremers WK,Lorenz E,Amer H,Cosio FG,Stegall MD,Gandhi MJ,Schinstock CA

doi

10.1111/ctr.13194

subject

Has Abstract

pub_date

2018-03-01 00:00:00

pages

e13194

issue

3

eissn

0902-0063

issn

1399-0012

journal_volume

32

pub_type

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