Risk factors for BK virus infection post transplantation

Transplant related risk

1.       Acute rejection episodes

2.       Cold ischemia time( the longer the more likely)

3.       Delayed graft function

4.       Ureteral stent placement

5.       Thymoglobulin induction

6.       Tacro/ MMF based regimen

Recipient related risk

1.       Older age

2.       Male

3.       Non African American

4.       DMII

Donor related risk ( now this is fascinating)

1.       BK Virus + donor

2.       Degree  of HLA mismatch

3.       HLA C7

Apparently there is growing evidence that the donor kidney might be the source of the BK virus.  Pre- transplant BK Screening of donors might identify the risked recipients post transplant.  Recipients of BK + donors developed BK viremia at earlier transplant time-points, had higher viral loads and slower clearing of the virus.  Even a recent study provides more evidence of this concept.

Overall, a nice review of BK Nephropathy was just published in NDT, where these risk factors are summarized.