Incidence, Risk Factors, and Outcomes of Kidney Transplant Recipients With BK Polyomavirus-Associated Nephropathy

Ryan Gately, Elasma Milanzi, Wai Lim, Armando Teixeira-Pinto, Phil Clayton, Nicole Isbel, David W. Johnson, Carmel Hawley, Scott Campbell, Germaine Wong

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Introduction: BK polyomavirus-associated nephropathy (BKPyVAN) is associated with graft dysfunction and loss; however, knowledge of immunosuppression reduction strategies and long-term graft, and patient outcomes across the disease spectrum is lacking. Methods: This cohort study included 14,697 kidney transplant recipients in Australia and New Zealand (2005−2019), followed for 91,306 person years. Results: BKPyVAN occurred in 460 recipients (3%) at a median posttransplant time of 4.8 months (interquartile range, 3.1−10.8). Graft loss (35% vs. 21%, P < 0.001), rejection (42% vs. 25%, P < 0.001), and death (18% vs. 13%, P = 0.002) were more common in the BKPyVAN group. The most frequent changes in immunosuppression after BKPyVAN were reduction (≤50%) in tacrolimus (172, 51%) and mycophenolate doses (134, 40%), followed by the conversion of mycophenolate to leflunomide (62, 19%) and tacrolimus to ciclosporin (20, 6%). Factors associated with the development of BKPyVAN included (adjusted hazard ratio [HR]; 95% confidence interval) male sex (1.66; 1.34−2.05), recipient age (≥70 vs. <20 [2.46; 1.30−4.65]), recipient blood group (A vs. B [2.00; 1.19−3.34]), donor age (≥70 vs. <20 [2.99; 1.71−5.22]), earlier era (1.74; 1.35−2.25), donor/recipient ethnic mismatch (1.52; 1.23−1.87), tacrolimus use (1.46; 1.11−1.91), and transplantation at a lower-volume transplant center (1.61; 1.24−2.09). The development of BKPyVAN was associated with an increased risk of all-cause (1.75; 1.46−2.09) and death-censored graft loss (2.49; 1.99−3.11), but not mortality (1.15; 0.91−1.45). Conclusions: BKPyVAN is associated with an increased risk of all-cause and death-censored graft loss, but not death. Interventional trials are urgently needed to evaluate the efficacy of immunosuppression reduction and novel strategies to minimize the adverse outcomes associated with BKPyVAN.

Original languageEnglish
Pages (from-to)531-543
Number of pages13
JournalKidney International Reports
Issue number3
Publication statusPublished - Mar 2023


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