Transplant infectious disease : an official journal of the Transplantation Society 2016 9 13() doi 10.1111/tid.12604
Although high-dose steroid therapy has been attempted for the management of clinically suspected allograft rejection, before testing for BK viral activity or acute cellular rejection accompanied by BKN, its long-term outcome remains unknown. We investigated the impact of high-dose steroids on BK viral activity and long-term graft outcomes in patients with BK viremia.
The study population comprised 144 kidney transplant recipients with BK viremia. They were divided into 2 groups based on the amount of steroids administered: low-dose group (<2 g, n = 123) or high-dose group (≥ 2 g, n = 21). RESULTS
The baseline serum BK viral loads were 5.4 ± 1.1 log cp/mL in the low-dose group and 6.0 ± 1.3 in the high-dose group (P = 0.054). These changed to 5.2 ± 1.3 and 6.1 ± 1.4, 1 month after steroid treatment (P = 0.03), and 4.9 ± 1.3 and 5.9 ± 1.4 at 2 months (P = 0.033), respectively. From 3 months to 1 year, the serum BK viral titers were not different between groups. Kaplan-Meier analyses demonstrated that the rates of the decline of graft function and graft failure were higher in the high-dose group (P = 0.02 and P = 0.04, respectively). High-dose steroids (P = 0.012, hazard ratio [HR] 5.04, 95% confidence interval [CI] 1.42-17.85) and log serum BK viral load at 2 months after steroid treatment (P = 0.042, HR 1.52, 95% CI 1.02-2.28) were independent risk factors of the decline of graft function.
High-dose steroids induced BK viral activation and subsequently resulted in poor long-term graft function and early graft failure in patients with BK viremia. This article is protected by copyright. All rights reserved.