Deceased-Donor Acute Kidney Injury and BK Polyomavirus in Kidney Transplant Recipients

Isaac E. Hall, Peter Philip Reese, Sherry G. Mansour, Sumit Mohan, Yaqi Jia, Heather R. Thiessen-Philbrook, Daniel C. Brennan, Mona D. Doshi, Thangamani Muthukumar, Enver Akalin, Meera Nair Harhay, Bernd Schröppel, Pooja Singh, Francis L. Weng, Jonathan S. Bromberg, Chirag R. Parikh

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND AND OBJECTIVES: BK polyomavirus (BKV) infection commonly complicates kidney transplantation, contributing to morbidity and allograft failure. The virus is often donor-derived and influenced by ischemia-reperfusion processes and disruption of structural allograft integrity. We hypothesized that deceased-donor AKI associates with BKV infection in recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 1025 kidney recipients from 801 deceased donors transplanted between 2010 and 2013, at 13 academic centers. We fitted Cox proportional-hazards models for BKV DNAemia (detectable in recipient blood by clinical PCR testing) within 1 year post-transplantation, adjusting for donor AKI and other donor- and recipient-related factors. We validated findings from this prospective cohort with analyses for graft failure attributed to BKV within the Organ Procurement and Transplantation Network (OPTN) database. RESULTS: The multicenter cohort mean kidney donor profile index was 49±27%, and 26% of donors had AKI. Mean recipient age was 54±13 years, and 25% developed BKV DNAemia. Donor AKI was associated with lower risk for BKV DNAemia (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79). In the OPTN database, 22,537 (25%) patients received donor AKI kidneys, and 272 (0.3%) developed graft failure from BKV. The adjusted hazard ratio for the outcome with donor AKI was 0.7 (95% confidence interval, 0.52 to 0.95). CONCLUSIONS: In a well-characterized, multicenter cohort, contrary to our hypothesis, deceased-donor AKI independently associated with lower risk for BKV DNAemia. Within the OPTN database, donor AKI was also associated with lower risk for graft failure attributed to BKV. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_03_10_CJN18101120_final.mp3.

Original languageEnglish (US)
Pages (from-to)765-775
Number of pages11
JournalClinical journal of the American Society of Nephrology : CJASN
Volume16
Issue number5
DOIs
StatePublished - May 8 2021

Keywords

  • acute kidney injury
  • kidney transplantation
  • transplant outcomes

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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