Real-world Experience of BKV Nephropathy Postrenal Transplantation: A Retrospective Analysis from 2000 to 2024
Pallavi Dubey, Mohammed Fahad Khan, Vishwanath Siddini, Mahesh Vankalakunti, Rohan Augustine, Ravi Jangamani, Kishore Babu, GK Prakash, Sanjay Rampure, Shilpa Shetty, H Sudarshan BallalBackground:
BK virus nephropathy (BKVN) poses significant challenges in kidney transplantation, often leading to graft dysfunction and loss. This study retrospectively evaluated incidence, risk factors, immunosuppression adjustments, and graft survival among kidney transplant (KT) recipients with BKVN from 2000 to 2024 at Manipal Hospital, Bangalore.
Materials and Methods:
All adult KT recipients with biopsy-confirmed BKVN as defined by histological viral cytopathy with SV40 positivity and/or plasma BK viral load >10
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copies/mL were included; those with incomplete data or <6 months follow-up were excluded. Clinical data were extracted from the institutional records. The continuous and categorical variables were summarized using standard descriptive statistics, with comparisons performed using Wilcoxon, Chi-square, or Fisher’s exact tests. Graft survival was assessed via Kaplan-Meier analysis, with
Results:
BKVN incidence was 1.29% (20/1541). Mean diagnosis occurred at 14.65 months posttransplant. Median estimated glomerular filtration rate declined significantly from 60.05 to 40.85 mL/min/1.73 m
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at diagnosis (Wilcoxon signed–rank test,
Conclusion:
Timely detection and standardized surveillance protocols are critical for the optimal outcomes. Prospective implementation of the proposed screening algorithm, coupled with BKV specific T-cell immunity assays, could clarify optimal viral load thresholds for intervention and prevent allograft dysfunction.