Methods: We retrospectively assessed the timing, clinical characteristics, screening adherence, and outcomes of early and late BKVN (biopsy-proven or presumptive [plasma BKV >10,000 DNA copies/mL) in a cohort of 671 consecutive patients who received a KT between 2008-2013 at a single US transplant center. Proportions were compared using fisher exact test with p<0.05 considered significant.
Results: Biopsy-proven [15 (15.5%)] or presumptive [82 (84.5%)]) BKVN was diagnosed in 97 patients (14.5%) at a median of 8.89 months post-KT. The number and percent of early vs late-onset was 80 (82.5%) and 17 (17.5%), respectively. Clinical characteristics (demographics, induction immunosuppression, rejection episodes) and outcomes (graft loss, renal dysfunction, death) were similar between the two groups (p >0.05 for all comparisons). Among those with late BKVN, 14 (82%) had no evidence of BK viremia within the first year post-KT while 3 (18%) had viremia detected but at a level <10,000 copies/mL. Adherence to screening was significantly lower in the late vs. early BKVN group: 72 (90%) vs. 11 (65%), respectively, p = 0.015.
Conclusion: In the era of BKV screening, late-onset BKVN accounts for a significant proportion of BKVN overall. Late-onset BKVN is associated with lower screening adherence, implying that it represents progression of undiagnosed earlier onset BKV infection. Improved first year screening adherence post-KT may decrease the incidence of late-onset BKVN. Recommendations for BKV screening beyond the first year after KT should be reassessed.
C. Fisher, None
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