BACKGROUND: Polyomavirus BK (BKV) infection of the renal allograft causes destructive tissue injury with inflammation and subsequent fibrosis. METHODS: Using a prospective cohort of patients after kidney transplantation performed between 2003 and 2012, we investigated the role of BKV viraemia in the development and progression of interstitial fibrosis and tubular atrophy (IFTA). The primary outcome was moderate-to-severe IFTA assessed by protocol biopsy at 36 months. RESULTS: A total of 207 consecutive recipients were enrolled. Of these, 57 (28%) developed BKV viraemia with 10 (5%) cases of polyomavirus-associated nephropathy (PVAN). Transient (<3 months) BKV viraemia occurred in 70% of patients, and persistent (≥3 months) BKV viraemia in 30%. A high viral load (≥10 000 copies/mL) was detected in 18% and a low viral load (<10 000 copies/mL) in 61%, while the viral load could not be determined in 21%. Moderate-to-severe IFTA was significantly increased in high [71%; odds ratio (OR) = 12.1; 95% confidence interval (CI) 1.62-90.0; P = 0.015] or persistent BKV viraemia (67%; OR = 6.33; 95% CI 1.19-33.7; P = 0.031) with corresponding rise in 'interstitial fibrosis + tubular atrophy' scores. Only patients with transient low BKV viraemia showed similar incidence and progression of IFTA to the no-BKV group. Persistent low BKV viraemia was uncommon yet the progression of fibrosis was significant. Only recipients with PVAN experienced inferior graft survival at 5 years. CONCLUSIONS: These data suggest that only transient low BKV viraemia does not negatively affect the progression of allograft fibrosis in contrast to excessive risk of severe fibrosis after high or persistent BKV viraemia.

• MeSH
• fibróza etiologie   patologie   MeSH
• homologní transplantace MeSH
• infekce onkogenními viry komplikace   virologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci ledvin etiologie   patologie   MeSH
• polyomavirové infekce komplikace   virologie   MeSH
• přežívání štěpu MeSH
• progrese nemoci MeSH
• prospektivní studie MeSH
• replikace viru MeSH
• transplantace ledvin škodlivé účinky   MeSH
• viremie komplikace   virologie   MeSH
• virová nálož * MeSH
• virus BK izolace a purifikace   patogenita   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

• MeSH
• cytomegalovirové infekce * MeSH
• Cytomegalovirus MeSH
• ganciklovir MeSH
• lidé MeSH
• valganciklovir MeSH
• viremie MeSH
• virus BK * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH
• práce podpořená grantem MeSH

Polyomavirus BK (BKV) is the cause of polyomavirus-associated nephropathy resulting in premature graft loss. There are limited data regarding the role of cytomegalovirus (CMV) infection and its prevention in developing BKV viremia and PVAN. In a prospective study, we analyzed 207 consecutive renal transplant recipients previously enrolled in 2 randomized trials evaluating different CMV prevention regimens with routine screening for BKV and CMV. Of these, 59 received valganciclovir and 100 valacyclovir prophylaxis; 48 patients were managed by preemptive therapy. At 3 years, the incidence of BKV viremia and PVAN was 28% and 5%, respectively. CMV DNAemia developed in 55% and CMV disease in 6%. Both BKV viremia (42% vs 23% vs 21%, P = .006) and PVAN (12% vs 2% vs 2%, P = .011) were increased in patients treated with valganciclovir prophylaxis compared to valacyclovir and preemptive therapy. Using multivariate Cox proportional hazard regression, valganciclovir prophylaxis was independent predictor of BKV viremia (hazard ratio [HR] = 2.38, P = .002) and PVAN (HR = 4.73, P = .026). In contrast, the risk of subsequent BKV viremia was lower in patients with antecedent CMV DNAemia (HR = 0.50, P = .018). These data suggest valganciclovir prophylaxis may be associated with increased risk of BKV viremia and PVAN. CMV DNAemia did not represent a risk for BKV.

• MeSH
• chronické selhání ledvin komplikace   chirurgie   MeSH
• cytomegalovirové infekce prevence a kontrola   MeSH
• Cytomegalovirus MeSH
• dospělí MeSH
• infekce onkogenními viry prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• multivariační analýza MeSH
• polyomavirové infekce virologie   MeSH
• premedikace MeSH
• přežívání štěpu MeSH
• proporcionální rizikové modely MeSH
• prospektivní studie MeSH
• randomizované kontrolované studie jako téma MeSH
• rizikové faktory MeSH
• transplantace ledvin škodlivé účinky   MeSH
• valaciclovir terapeutické užití   MeSH
• valganciklovir terapeutické užití   MeSH
• viremie etiologie   MeSH
• virus BK MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH