1193. Retransplantation after Kidney Graft Loss due to BK Nephropathy: A Single Center Experience
Session: Poster Abstract Session: Non-CMV Viruses and Transplantation
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • BK Retransplantation Poster IDSA 09.21.11 Arial Font.pdf (659.3 kB)
  • Background: 

    BKVN is a significant problem that affects 3-8% of all kidney transplants (KT) and remains a cause of graft loss. Retransplantation (ReTx) after graft loss due to BKVN is feasible, but the limited available literature suggests a higher rate of recurrent disease.

    Methods: 

    After IRB approval, a single center retrospective cohort study of all KT recipients who underwent ReTx after graft loss secondary to BKVN from 1/06 to 8/10 was undertaken.  

    Results: 

    8 patients (pts) were identified who underwent ReTx after graft failure due to BKVN during the studied time period.  7 of these pts had a transplant nephrectomy prior to or on the same day as the ReTx.  7/8 pts received basiliximab (BAS) induction and all underwent monthly assessments of BK PCR.  7 pts developed BK viruria post-transplant at a median of 4 wks, 2 pts developed BK viremia at a median of 6 wks and 1 patient had recurrence of BKVN at 79 wks with graft failure and another ReTx. This patient was an initial SPK transplant and was treated with reduction of immune suppression upon diagnosis of BKVN; aggressive reduction was not attempted due to a functional pancreatic graft. The patient lost the 2nd kidney graft 37 wks after BKVN diagnosis despite cidofovir (CID) and leflunomide (LEF) therapy. BKVN developed in 4.7% of our primary KT population.

    Conclusion: 

    This is the largest case series of ReTx following graft failure secondary to BKVN from a single center.  Our protocol, which includes removal of prior grafts, non-lymphocyte depletion induction, close monitoring and early reduction of immune suppression appears to be associated with low rates of recurrent BKVN.

    Table 1. Timeline of 8 pts with graft failure due to BKVN and ReTx

    Pt Age

    Sex

    Type of Initial Transplant

    Timing of Transplant Nephrectomy

    ReTx Type

    Induction

    Onset of BK viruria

    (days)

    Intervention

    Onset of BK viremia

    (days)

    Intervention

    Onset of BKVN (days)

    Intervention

    40

    F

    LUKT

    At ReTx

    CKT

    BAS

     

     

     

     

     

     

    58

    M

    SPK

    1 month pre- ReTx

    LUKT

    Alemtuzumab

    1

    None

    39

    CNI dec; MMF switch to LEF

     

    IS adjusted; CID and LEF; eventual retransplant

    53

    M

    LUKT

    At ReTx

    LUKT

    BAS

    42

    None

     

     

     

     

    51

    M

    SPK

    At ReTx

    CKT

    BAS

    unknown

    unk

    unk

    unk

    555

     

    52

    M

    LRKT

    At ReTx

    LRKT

    BAS

    31

    CNI dec

     

     

     

     

    56

    M

    CKT

    2 months post- ReTx

    CKT

    BAS

    228

    CNI, Pred dec

     

     

     

     

    56

    F

    LUKT

    1 month pre- ReTx

    LRKT

    BAS

    16

    MMF switch to LEF

     

     

     

     

    48

    F

    SPK

    11 months pre- ReTx

    LUKT

    BAS

    28

    MMF dec

     

     

     

     


    Subject Category: O. Transplant infectious diseases

    Nicole Theodoropoulos, MD1, Valentina Stosor, MD1, Michael Angarone, DO1, Sudhir Penugonda, MD MPH1, Eileen DeMayo2, Joseph Leventhal, MD1, John Friedewald, MD1 and Michael G. Ison, MD, MS1, (1)Northwestern University Feinberg School of Medicine, Chicago, IL, (2)Northwestern Memorial Hospital, Chicago, IL

    Disclosures:

    N. Theodoropoulos, None

    V. Stosor, None

    M. Angarone, None

    S. Penugonda, None

    E. DeMayo, None

    J. Leventhal, None

    J. Friedewald, None

    M. G. Ison, Chimerix: Collaborator, DSMB and Research support

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.