Kidney transplant recipients with polycystic kidney disease have a lower risk of post‐transplant BK BK infection than those with end‐stage renal disease due to other causes

摘要

Abstract Background Polyomavirus‐associated nephropathy is associated with high risk of kidney allograft loss. Whether the cause of native end‐stage renal disease influences the risk of BK infection is unclear. Methods A retrospective, single‐center study of 2741 adult kidney transplant recipients between 1994 and 2014 was performed. Recipients had end‐stage renal disease due to polycystic kidney disease ( PKD , n?=?549), diabetes mellitus ( DM , n?=?947), hypertension ( HTN , n?=?442), or glomerulonephritis ( GN , n?=?803). Results A total of 327 recipients (12%) developed post‐transplant BK viremia over a median follow‐up time of 5?years. The incidence rate of BK viremia was lowest in patients with PKD (1.46 per 100 person‐years) compared to other causes of ESRD ( DM ?=?2.06, HTN ?=?2.65, and GN ?=?2.01 per 100 person‐years). A diagnosis of PKD was associated with a lower risk of post‐transplant BK viremia (adjusted HR (95% CI )?=?0.67 (0.48‐0.95), P ?=?0.02). BK nephropathy was significantly less common in patients with PKD (0.21 per 100 person‐years) compared to those with HTN (0.80 per 100 person‐years, P ?≤?0.001). Among patients with PKD , the risk of BK viremia was lower in patients with nephrectomy, compared to those without nephrectomy (adjusted HR (95% CI )?=?0.42 (0.19‐0.92), P ??0.05). Conclusion ESRD due to PKD is associated with a lower risk of post‐transplant BK infection. The renal tubular epithelial cells in PKD are unique; they are in a proliferative but non‐differentiated state. Whether this characteristic of renal tubular epithelial cells alters the BK viral reservoir or replication in PKD patients warrants further study.