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Characterizing the Impact of Induction Therapy on BK Polyoma Viral Reactivation: A Single-Center Analysis
Journal article   Peer reviewed

Characterizing the Impact of Induction Therapy on BK Polyoma Viral Reactivation: A Single-Center Analysis

Shahed Ammar, Patrick Ten Eyck, David Axelrod, Chen S Tan and Sarat Kuppachi
Transplantation proceedings, Vol.58(3), pp.441-446
04/2026
DOI: 10.1016/j.transproceed.2026.01.023
PMID: 41763935

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Abstract

BKPyV following kidney transplantation is well recognized to cause premature graft failure and ureteral complications. Cumulative immunosuppression, including induction therapy, has a sustained impact on immune responses to opportunistic infection. We hypothesized that induction with cell-depleting agents affects the 1-year risk of BKPyV reactivation.PURPOSEBKPyV following kidney transplantation is well recognized to cause premature graft failure and ureteral complications. Cumulative immunosuppression, including induction therapy, has a sustained impact on immune responses to opportunistic infection. We hypothesized that induction with cell-depleting agents affects the 1-year risk of BKPyV reactivation.Of 456 adult patients who underwent kidney transplants between January 2018 and February 2023 with at least 12 months of follow-up were screened for BK virus by blood PCR at 1.5, 3,6,9,12 months.METHODSOf 456 adult patients who underwent kidney transplants between January 2018 and February 2023 with at least 12 months of follow-up were screened for BK virus by blood PCR at 1.5, 3,6,9,12 months.Among the 456 patients, 101 (22.1%) developed BKPyV viremia. The incidence of BKPyV positivity was highest with basiliximab (32%) compared to alemtuzumab (21%) and thymoglobulin (18%) (p = .032). Compared to basiliximab, receiving alemtuzumab (OR: 0.571, 95% CI: 0.329-0.991, p = .042) or thymoglobulin (OR: 0.462, 95% CI: 0.256-0.834, p = .010) was associated with a significantly lower risk of BKPyV. Higher KDPI was also significantly associated with an increased risk of BKPyV infection (OR: 1.120, 95% CI: 1.013-1.238, p = .026). Multivariable analysis showed a persistently significant lower risk of BKPyV infection with thymoglobulin (OR: 0.4, 95% CI: 0.21-0.75, p = .004) and alemtuzumab (OR: 0.5, 95% CI: 0.28-0.89, p = .019) compared to basiliximab. Also, higher KDPI was independently associated with BKPyV viremia (OR: 1.13, 95% CI: 1.01-1.25, p = .031).RESULTSAmong the 456 patients, 101 (22.1%) developed BKPyV viremia. The incidence of BKPyV positivity was highest with basiliximab (32%) compared to alemtuzumab (21%) and thymoglobulin (18%) (p = .032). Compared to basiliximab, receiving alemtuzumab (OR: 0.571, 95% CI: 0.329-0.991, p = .042) or thymoglobulin (OR: 0.462, 95% CI: 0.256-0.834, p = .010) was associated with a significantly lower risk of BKPyV. Higher KDPI was also significantly associated with an increased risk of BKPyV infection (OR: 1.120, 95% CI: 1.013-1.238, p = .026). Multivariable analysis showed a persistently significant lower risk of BKPyV infection with thymoglobulin (OR: 0.4, 95% CI: 0.21-0.75, p = .004) and alemtuzumab (OR: 0.5, 95% CI: 0.28-0.89, p = .019) compared to basiliximab. Also, higher KDPI was independently associated with BKPyV viremia (OR: 1.13, 95% CI: 1.01-1.25, p = .031).Induction therapy and higher KDPI were significant risk factors for BKPyV reactivation. Induction with cell-depleting agents lowered the risk of BKPyV, perhaps due to the subsequent use of lower maintenance immunosuppression and reduced need for acute rejection treatment.CONCLUSIONInduction therapy and higher KDPI were significant risk factors for BKPyV reactivation. Induction with cell-depleting agents lowered the risk of BKPyV, perhaps due to the subsequent use of lower maintenance immunosuppression and reduced need for acute rejection treatment.

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