Pretransplantation donor-recipient pair seroreactivity against BK polyomavirus predicts viremia and nephropathy after kidney transplantation

Kidney transplant donors are currently not implicated in predicting BK polyomavirus (BKPyV) infection in kidney transplant recipients. It has been postulated, however, that BKPyV infection originates from the kidney allograft. Since BKPyV-seroreactivity correlates with BKPyV-replication and, therefore, might mirror the infectious load, we investigated whether BKPyV-seroreactivity of the donor predicts viremia and BKPyV-associated nephropathy (BKPyVAN) in the recipient. In a retrospective cohort of 407 living kidney donor-recipient pairs pretransplantation donor and recipient sera were tested for BKPyV IgG-levels and correlated with the occurrence of recipient BKPyV viremia and BKPyVAN within one year posttransplantation. As such, donor BKPyV IgG-level was strongly associated with BKPyV viremia and BKPyVAN (p < 0.001), while recipient BKPyV-seroreactivity showed a non-significant inverse trend. Pairing of high BKPyV-seroreactive donors with low seroreactive recipients resulted in a 10-fold increased risk for BKPyV viremia (HR 10.1, 95% CI: 3.5 – 29.0, p < 0.001). In multivariate analysis, donor BKPyV-seroreactivity was the strongest pretransplantation factor associated with viremia (p < 0.001) and BKPyVAN (p = 0.007). The proportional relation between donor BKPyV-seroreactivity and recipient infection suggests that donor BKPyV-seroreactivity reflects the infectious load of the kidney allograft, and calls for the use of pretransplantation BKPyV-serological testing of (potential) donors and recipients (read more) Print this post