TY - JOUR
T1 - De novo donor-specific antibody following BK nephropathy
T2 - The incidence and association with antibody-mediated rejection
AU - Cheungpasitporn, Wisit
AU - Kremers, Walter K.
AU - Lorenz, Elizabeth
AU - Amer, Hatem
AU - Cosio, Fernando G.
AU - Stegall, Mark D.
AU - Gandhi, Manish J.
AU - Schinstock, Carrie A.
N1 - Funding Information:
This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Publisher Copyright:
© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2018/3
Y1 - 2018/3
N2 - Background and objectives: The risk of de novo donor-specific antibody (dnDSA) development following BK viremia (BKV) or nephropathy (BKN) after kidney transplant remains unclear. We aimed to evaluate the relationships among dnDSA, BKV (BK blood PCR > 15 000 copies), BKN, antibody-mediated rejection (AMR), and allograft loss. Patients and methods: We performed a retrospective cohort study of 904 solitary kidney transplant recipients transplanted between 10/2007 and 5/2014. Cox proportional hazards regression with time-dependent covariates were used to assess the relationships among BKN, isolated BKV, dnDSA, and the subsequent risk of AMR and allograft loss. Results: In multivariate analysis, we observed that BKN, but not BKV was a risk factor for dnDSA (HR, 3.18, P =.008). Of the patients with BK nephropathy, 14.0% (6/43) developed dnDSA, which occurred within 14 months of BK diagnosis. DnDSA in this setting remains a risk factor for subsequent AMR (HR 4.75, P =.0001) and allograft loss (HR 2.63, P =.018). Conclusions: BKN is an independent risk factor for development of dnDSA. Improved understanding of the characteristics of patients with BKN who are at highest risk for development of dnDSA would be valuable to customize immunosuppression reduction in this population.
AB - Background and objectives: The risk of de novo donor-specific antibody (dnDSA) development following BK viremia (BKV) or nephropathy (BKN) after kidney transplant remains unclear. We aimed to evaluate the relationships among dnDSA, BKV (BK blood PCR > 15 000 copies), BKN, antibody-mediated rejection (AMR), and allograft loss. Patients and methods: We performed a retrospective cohort study of 904 solitary kidney transplant recipients transplanted between 10/2007 and 5/2014. Cox proportional hazards regression with time-dependent covariates were used to assess the relationships among BKN, isolated BKV, dnDSA, and the subsequent risk of AMR and allograft loss. Results: In multivariate analysis, we observed that BKN, but not BKV was a risk factor for dnDSA (HR, 3.18, P =.008). Of the patients with BK nephropathy, 14.0% (6/43) developed dnDSA, which occurred within 14 months of BK diagnosis. DnDSA in this setting remains a risk factor for subsequent AMR (HR 4.75, P =.0001) and allograft loss (HR 2.63, P =.018). Conclusions: BKN is an independent risk factor for development of dnDSA. Improved understanding of the characteristics of patients with BKN who are at highest risk for development of dnDSA would be valuable to customize immunosuppression reduction in this population.
KW - BK nephropathy
KW - antibody-mediated rejection
KW - donor-specific antibody
KW - immunosuppression
KW - kidney transplantation
KW - polyomavirus
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U2 - 10.1111/ctr.13194
DO - 10.1111/ctr.13194
M3 - Article
C2 - 29315820
AN - SCOPUS:85041732532
SN - 0902-0063
VL - 32
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 3
M1 - e13194
ER -