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BK Virus Nephropathy in Pediatric Renal Transplant Recipients: An Analysis of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Registry

Jodi M. Smith^*, Vikas R. Dharnidharka, Lynya Talley, Karen Martz, and Ruth A. McDonald^*

^* Department of Pediatrics, Division of Nephrology, Children's Hospital and Regional Medical Center, University of Washington, Seattle, Washington; Division of Pediatric Nephrology, University of Florida College of Medicine, Gainesville, Florida; and EMMES Corp., Rockville, Maryland

Address correspondence to: Dr. Jodi M. Smith, Division of Nephrology, Children's Hospital and Regional Medical Center, University of Washington, 4800 Sand Point Way NE, M1–5, Seattle, WA 98105. Phone: 206-987-2524; Fax: 206-987-2636; E-mail: jodi.smith{at}seattlechildrens.org

Background and Objectives: There is limited information regarding BK virus nephropathy in pediatric kidney transplantation. The objective of this study was to evaluate cases of BK virus nephropathy in the North American Pediatric Renal Trials and Collaborative Studies database.

Design, Setting, Participants, & Measurements: Using a questionnaire that was sent to North American Pediatric Renal Trials and Collaborative Studies centers, we assessed the incidence, risk factors, clinical features, and outcomes of BK virus nephropathy in pediatric renal transplant recipients who received a transplant between 2000 and 2004.

Results: BK virus nephropathy was reported in 25 (4.6%) of 542 patients at a median onset of 10.1 mo after transplantation. The median age was 11 yr. All patients who were tested reported BK viruria, and 19 (91%) of 21 who had plasma tested reported BK viremia. Treatment of BK virus nephropathy included reduction of immunosuppression (84%), cidofovir (24%), leflunomide (8%), and intravenous Ig (20%). Simultaneous rejection treatment was reported in four (16%). The median creatinine was 2.0 mg/dl at a mean follow-up of 24 mo. There were six (24%) graft failures in the patients with BK virus nephropathy at a mean of 24 mo after diagnosis. Rejection occurred in eight (32%) after diagnosis. Multivariate analysis showed that use of polyclonal induction therapy and zero HLA DR mismatch were associated with the development of BK virus nephropathy.

Conclusions: This first multicenter, retrospective, cohort study of BK virus nephropathy in pediatric renal transplant recipients found a BK virus nephropathy incidence of 4.6% and identified polyclonal induction and zero HLA DR mismatch as significant risk factors for BK virus nephropathy.

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