Results of repeat renal transplantation after graft loss from BK virus nephropathy

Background.: BK virus nephropathy (BKVN) is an important cause of renal graft loss in recent years. The aims of this study are to (1) describe the management of patients undergoing retransplantation after allograft loss in the setting of BKVN and (2) to identify risk factors for BK virus replication in the retransplant. Methods.: This retrospective study compiled data on adult patients undergoing repeat transplantation after previous loss of allograft to BKVN from six US centers. Clinical, laboratory, and histopathologic data for both the transplant that failed because of BKVN and the retransplant were abstracted and reviewed. Results.: A total of 31 patients underwent retransplantation after a median of 6 months after failure of the first allograft, with 10 of 31 undergoing preemptive retransplantation. Twenty-six patients had documented clearance of viremia and 13 underwent transplant nephrectomy before the retransplant. Two of six centers had changed immunosuppression protocols for the retransplants. After repeat transplant, 11 (35%) had BKV replication in urine and plasma with two patients experiencing BKVN. Seven had acute rejection. In univariate analysis, documented viremia clearance after BKVN in the initial transplant was significantly associated with the absence of BKV replication after repeat transplantation. Serum creatinine was significantly higher at 1 year in patients with BKV replication. One graft loss occurred due to rejection. Conclusions.: Retransplantation is safe and effective for patients with previous graft loss due to BKVN preferably post-BK viral clearance.