Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients With Biopsy Proven BK Polyomavirus Associated Nephropathy
Introduction: The absolute BK viral load is an important diagnostic surrogate for BK polyomavirus associated nephropathy (PyVAN) after renal transplant (KTX) and serial assessment of BK viremia is recommended. However, there is no data indicating which particular viral load change, i.e., absolute vs...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-01-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.791087/full |
| _version_ | 1798035246462009344 |
|---|---|
| author | Haris Omić Johannes Phillip Kläger Harald Herkner Stephan W. Aberle Heinz Regele Lukas Weseslindtner Tarek Arno Schrag Gregor Bond Katharina Hohenstein Bruno Watschinger Johannes Werzowa Robert Strassl Michael Eder Željko Kikić |
| author_facet | Haris Omić Johannes Phillip Kläger Harald Herkner Stephan W. Aberle Heinz Regele Lukas Weseslindtner Tarek Arno Schrag Gregor Bond Katharina Hohenstein Bruno Watschinger Johannes Werzowa Robert Strassl Michael Eder Željko Kikić |
| author_sort | Haris Omić |
| collection | DOAJ |
| description | Introduction: The absolute BK viral load is an important diagnostic surrogate for BK polyomavirus associated nephropathy (PyVAN) after renal transplant (KTX) and serial assessment of BK viremia is recommended. However, there is no data indicating which particular viral load change, i.e., absolute vs. relative viral load changes (copies/ml; percentage of the preceding viremia) is associated with worse renal graft outcomes.Materials and Methods: In this retrospective study of 91 biopsy proven PyVAN, we analyzed the interplay of exposure time, absolute and relative viral load kinetics, baseline risk, and treatment strategies as risk factors for graft loss after 2 years using a multivariable Poisson-model.Results: We compared two major treatment strategies: standardized immunosuppression (IS) reduction (n = 53) and leflunomide (n = 30). The median viral load at the index biopsy was 2.15E+04 copies/ml (interquartile range [IQR] 1.70E+03–1.77E+05) and median peak viremia was 3.6E+04 copies/ml (IQR 2.7E+03–3.3E+05). Treatment strategies and IS-levels were not related to graft loss. After correction for baseline viral load and estimated glomerular filtration rate (eGFR), absolute viral load decrease/unit remained an independent risk factor for graft loss [incidence rate ratios [IRR] = 0.77, (95% CI 0.61–0.96), p = 0.02].Conclusion: This study provides evidence for the prognostic importance of absolute BK viremia kinetics as a dynamic parameter indicating short-term graft survival independently of other established risk factors. |
| first_indexed | 2024-04-11T20:55:33Z |
| format | Article |
| id | doaj.art-50e30ea30dbb4a8d9371f24cb23bf826 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-11T20:55:33Z |
| publishDate | 2022-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-50e30ea30dbb4a8d9371f24cb23bf8262022-12-22T04:03:42ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-01-01810.3389/fmed.2021.791087791087Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients With Biopsy Proven BK Polyomavirus Associated NephropathyHaris Omić0Johannes Phillip Kläger1Harald Herkner2Stephan W. Aberle3Heinz Regele4Lukas Weseslindtner5Tarek Arno Schrag6Gregor Bond7Katharina Hohenstein8Bruno Watschinger9Johannes Werzowa10Robert Strassl11Michael Eder12Željko Kikić13Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Pathology, Medical University of Vienna, Vienna, AustriaDepartment of Emergency Medicine, Medical University of Vienna, Vienna, AustriaCenter for Virology, Medical University of Vienna, Vienna, AustriaDepartment of Pathology, Medical University of Vienna, Vienna, AustriaCenter for Virology, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Orthopedics and Trauma Surgery at the Medical University of Vienna in the General Hospital, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, AustriaLudwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, AustriaDivision of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, AustriaDivision of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Urology, Medical University of Vienna, Vienna, AustriaIntroduction: The absolute BK viral load is an important diagnostic surrogate for BK polyomavirus associated nephropathy (PyVAN) after renal transplant (KTX) and serial assessment of BK viremia is recommended. However, there is no data indicating which particular viral load change, i.e., absolute vs. relative viral load changes (copies/ml; percentage of the preceding viremia) is associated with worse renal graft outcomes.Materials and Methods: In this retrospective study of 91 biopsy proven PyVAN, we analyzed the interplay of exposure time, absolute and relative viral load kinetics, baseline risk, and treatment strategies as risk factors for graft loss after 2 years using a multivariable Poisson-model.Results: We compared two major treatment strategies: standardized immunosuppression (IS) reduction (n = 53) and leflunomide (n = 30). The median viral load at the index biopsy was 2.15E+04 copies/ml (interquartile range [IQR] 1.70E+03–1.77E+05) and median peak viremia was 3.6E+04 copies/ml (IQR 2.7E+03–3.3E+05). Treatment strategies and IS-levels were not related to graft loss. After correction for baseline viral load and estimated glomerular filtration rate (eGFR), absolute viral load decrease/unit remained an independent risk factor for graft loss [incidence rate ratios [IRR] = 0.77, (95% CI 0.61–0.96), p = 0.02].Conclusion: This study provides evidence for the prognostic importance of absolute BK viremia kinetics as a dynamic parameter indicating short-term graft survival independently of other established risk factors.https://www.frontiersin.org/articles/10.3389/fmed.2021.791087/fullpolyomavirus nephropathyviral loadviral kineticgraft survivalrenal transplantation |
| spellingShingle | Haris Omić Johannes Phillip Kläger Harald Herkner Stephan W. Aberle Heinz Regele Lukas Weseslindtner Tarek Arno Schrag Gregor Bond Katharina Hohenstein Bruno Watschinger Johannes Werzowa Robert Strassl Michael Eder Željko Kikić Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients With Biopsy Proven BK Polyomavirus Associated Nephropathy Frontiers in Medicine polyomavirus nephropathy viral load viral kinetic graft survival renal transplantation |
| title | Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients With Biopsy Proven BK Polyomavirus Associated Nephropathy |
| title_full | Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients With Biopsy Proven BK Polyomavirus Associated Nephropathy |
| title_fullStr | Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients With Biopsy Proven BK Polyomavirus Associated Nephropathy |
| title_full_unstemmed | Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients With Biopsy Proven BK Polyomavirus Associated Nephropathy |
| title_short | Clinical Relevance of Absolute BK Polyoma Viral Load Kinetics in Patients With Biopsy Proven BK Polyomavirus Associated Nephropathy |
| title_sort | clinical relevance of absolute bk polyoma viral load kinetics in patients with biopsy proven bk polyomavirus associated nephropathy |
| topic | polyomavirus nephropathy viral load viral kinetic graft survival renal transplantation |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.791087/full |
| work_keys_str_mv | AT harisomic clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT johannesphillipklager clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT haraldherkner clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT stephanwaberle clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT heinzregele clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT lukasweseslindtner clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT tarekarnoschrag clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT gregorbond clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT katharinahohenstein clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT brunowatschinger clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT johanneswerzowa clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT robertstrassl clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT michaeleder clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy AT zeljkokikic clinicalrelevanceofabsolutebkpolyomaviralloadkineticsinpatientswithbiopsyprovenbkpolyomavirusassociatednephropathy |