Onset and progression of de novo donor-specific anti-human leukocyte antigen antibodies after BK polyomavirus and preemptive immunosuppression reduction
G. Dieplinger
Terasaki Research Institute, Los Angeles, California, USA
These authors are co-first authors.Search for more papers by this authorCorresponding Author
M.J. Everly
Terasaki Research Institute, Los Angeles, California, USA
These authors are co-first authors.Correspondence to:
Dr. Matthew J. Everly, Terasaki Research Institute, 11570 W. Olympic Blvd., Los Angeles, CA 90064, USA
Tel: 310-479-6101
Fax: 310-445-3381
E-mail: [email protected]
Search for more papers by this authorK.P. Briley
Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorC.E. Haisch
Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorP. Bolin
Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorA.Q. Maldonado
Vidant Medical Center, Greenville, North Carolina, USA
Search for more papers by this authorW.T. Kendrick
Eastern Nephrology Associates, Greenville, North Carolina, USA
Search for more papers by this authorS.A. Kendrick
Eastern Nephrology Associates, Greenville, North Carolina, USA
Search for more papers by this authorC. Morgan
Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorP.I. Terasaki
Terasaki Research Institute, Los Angeles, California, USA
Search for more papers by this authorL.M. Rebellato
Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorG. Dieplinger
Terasaki Research Institute, Los Angeles, California, USA
These authors are co-first authors.Search for more papers by this authorCorresponding Author
M.J. Everly
Terasaki Research Institute, Los Angeles, California, USA
These authors are co-first authors.Correspondence to:
Dr. Matthew J. Everly, Terasaki Research Institute, 11570 W. Olympic Blvd., Los Angeles, CA 90064, USA
Tel: 310-479-6101
Fax: 310-445-3381
E-mail: [email protected]
Search for more papers by this authorK.P. Briley
Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorC.E. Haisch
Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorP. Bolin
Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorA.Q. Maldonado
Vidant Medical Center, Greenville, North Carolina, USA
Search for more papers by this authorW.T. Kendrick
Eastern Nephrology Associates, Greenville, North Carolina, USA
Search for more papers by this authorS.A. Kendrick
Eastern Nephrology Associates, Greenville, North Carolina, USA
Search for more papers by this authorC. Morgan
Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorP.I. Terasaki
Terasaki Research Institute, Los Angeles, California, USA
Search for more papers by this authorL.M. Rebellato
Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
Search for more papers by this authorAbstract
Background
BK polyomavirus (BKPyV) viremia/nephropathy and reduction in immunosuppression following viremia may increase the risk of alloimmune activation and allograft rejection. This study investigates the impact of BKPyV viremia on de novo donor anti-human leukocyte antigen (HLA)-specific antibodies (dnDSA).
Patients and methods
All primary renal transplants at East Carolina University from March 1999 to December 2010, with at least 1 post-transplant BKPyV viral load testing, were analyzed. Patients were negative for anti-HLA antibodies to donor antigens (tested via single antigen beads) at transplantation and at first BKPyV testing.
Results
Nineteen of 174 patients (11%) tested positive for BKPyV viremia. Within 24 months of BKPyV viremia detection, 79% of BKPyV-viremic patients developed dnDSA. Only 20% of BKPyV viremia-persistent cases, compared to 86% of BKPyV viremia-resolved cases, developed dnDSA (P = 0.03). Poor allograft survival was evident in BKPyV viremia-persistent patients (60% failure by 2 years post BKPyV diagnosis) and in BKPyV viremia-resolved patients with dnDSA (5-year post BKPyV diagnosis allograft survival of 48%).
Conclusions
Post-transplant BKPyV viremia and preemptive immunosuppression reduction is associated with high rates of dnDSA. When preemptively treating BKPyV viremia, dnDSA should be monitored to prevent allograft consequences.
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