A case‐control study to assess the role of polyomavirus in transplant complications: Where do we stand?

Purpose The study's aim was to assess whether polyomavirus DNAemia screening was associated with different outcomes in patients with positive viremia compared with negative viremia. Methods Case‐control retrospective study of patients with polyomavirus DNAemia (viremia > 1000 copies/mL) matc...

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Published in:	Transplant infectious disease Vol. 22; no. 6; pp. e13432 - n/a
Main Authors:	Garcia Urbán, Julia, Gurrado, Katia, Brea Rivas, Paola C., Abou Elrous, Dina, Zubimendi Machain, Mónica, Romero Gómez, María, García Rodríguez, Julio, Vicandi Plaza, Blanca, Yébenes Gregorio, Laura, García Fernández, Eugenia, Jiménez Martín, Carlos, López Oliva, María‐Ovidia, González García, Elena, Ledesma Sánchez, Gabriel, Carreño Cornejo, Gilda, Selgas Gutiérrez, Rafael, Zarauza Santoveña, Alejandro, Melgosa Hijosa, Marta, Fernández Camblor, Carlota, Mozo del Castillo, Yasmina, Sisinni, Luisa, Bueno Sánchez, David, Pérez‐Martínez, Antonio, Sánchez Zapardiel, Elena, López Granados, Eduardo, Monserrat Villatoro, Jaime, Hernández Zabala, Rafael, Borobia, Alberto M., Frías, Jesús, Ramírez, Elena
Format:	Journal Article
Language:	English
Published:	Denmark Wiley Subscription Services, Inc 01-12-2020
Subjects:	BK polyomavirus BKPyV Complications Graft rejection hematopoietic cell transplant Hematopoietic stem cells Immunosuppression Immunosuppressive agents immunosuppressive treatment Kidney transplantation Risk analysis Risk factors solid organ transplantation Stem cell transplantation Stem cells transplant Transplantation Transplants & implants Viremia hematopoietic cell transplant BKPyV solid organ transplantation transplant immunosuppressive treatment BK polyomavirus
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Summary:	Purpose The study's aim was to assess whether polyomavirus DNAemia screening was associated with different outcomes in patients with positive viremia compared with negative viremia. Methods Case‐control retrospective study of patients with polyomavirus DNAemia (viremia > 1000 copies/mL) matched 1:1 with controls. Control group consists of the patient who received a transplant immediately before or after each identified case and did have nil viremia. Finding Ultimately, 120 cases of BK polyomavirus (BKPyV) were detected and matched with 130 controls. Of these, 54 were adult kidney transplant recipients (KTRs), 43 were pediatric KTRs, and 23 were undergoing hemato‐oncologic therapy, of which 20 were undergoing hematopoietic stem cell transplantation. The odds ratio (OR) for overall risk of poorer outcomes in cases versus controls was 16.07 (95% CI: 5.55‐46.54). The unfavorable outcome of switching the immunosuppressive drug (ISD) (14/40,35%) was no different from that of those treated with reduced ISD doses (31/71, 43.6%, P = .250). Acute rejection or graft‐versus‐host disease, previous transplant, and intensity of immunosuppression (4 ISDs plus induction or conditioning) were risk factors for BKPyV‐DNAemia (OR: 13.96, 95% CI: 11.25‐15.18, P < .001; OR: 6.14, 95% CI: 3.91‐8.80, P < .001; OR: 5.53, 95% CI: 3.37‐7.30, P < .001, respectively). Conclusions Despite viremia screening, dose reduction, and change in therapeutic protocol, patients with positive BKPyV‐DNAemia present poorer outcomes and unfavorable results.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1398-2273 1399-3062
DOI:	10.1111/tid.13432