TABLE 2.
Risk factors of BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy in kidney transplantation
| BKPyV-DNAemiaa | Biopsy-proven BKPyV-nephropathyb | ||
|---|---|---|---|
| Risk factor | Evidence levelc | Risk factor | Evidence levelc |
| Donor factors | Donor factors | ||
| Urinary BKPyV shedding | Low, C | Urinary BKPyV shedding | Low, C |
| BKPyV genotypes and subgenotypes | Very low, D | BKPyV genotypes and subgenotypes | Very low, D |
| BKPyV-seropositive antibodyd status (D+) if antibody levels are very high in living donors | Low, C | BKPyV genotypes different from the recipient (mismatching) | Very low, D |
| BKPyV genotypes different from the recipient (mismatching) | Very low, D | ||
| LVGR polymorphisms | Very low, D | ||
| Recipient factors | Recipient factors | ||
| Older recipient age | Moderate, B | Older recipient age | Low, C |
| Male recipient sex | Moderate, B | Male recipient sex | Low, C |
| BKPyV-seronegative recipient antibody status (R–) if the donor is BKPyV-seropositive D+ | Moderate, B | ||
| Low recipient neutralizing antibodye levels against the donor BKPyV serotype | Very low, D | Low recipient neutralizing antibody levelse against the donor BKPyV serotype | Very low, D |
| Previous kidney transplantation | Low, C | ||
| HLA class I (absence of A2, B7, B8, B51, B44, B51, B13, CW7) | Very low, D | ||
| HLA class II (DR15) | Very low, D | HLA-E*01:03 vs protective HLA-E*01:01 | Very low, D |
| Interferon-γ gene rs2435061 | Very low, D | ||
| Younger pediatric recipient age | Very low, D | ||
| Obstructive uropathy as primary renal disease of pediatric recipients | Very low, D | ||
| Transplantation factors | Transplantation factors | ||
| Tacrolimus (compared with cyclosporine A) | High, A | Tacrolimus (compared with cyclosporine A) | High, A |
| Lymphocyte-depleting agents | Low, C | Lymphocyte-depleting agents | Low, C |
| Acute rejection | Low, C | Acute rejection | Low, C |
| Corticosteroids (higher maintenance; cumulative, rejection therapy) | Moderate, B | Corticosteroids (higher maintenance; cumulative, rejection therapy) | Moderate, B |
| mTOR inhibitors (decrease risk) | Low, C | mTOR inhibitors (decrease risk) | Low, C |
| Ureteric stents | Low, C | Ureteric stents | Low, C |
| BKPyV genome rearranged NCCR | Low, C | ||
| ABOi kidney transplantation | Low, C | ||
LVGR encodes agnoprotein and capsid proteins Vp1, Vp2, and Vp3. NCCR harbors the origin of viral DNA replication and transcription promoter/enhancer elements.
Defined as >1000 c/mL (or equivalent) for >2wk (probable BKPyV-nephropathy) or increasing >10 000 c/mL or equivalent (presumptive BKPyV-nephropathy).
Defined as biopsy-proven BKPyV-nephropathy using histological evidence and demonstrating BKPyV-specific involvement.4
Based on a literature review using the GRADE classification.
Measured using ELISA with coated antigens of the major capsid protein Vp1 or the Vp1-derived virus-like particles.
Measured using infectious BKPyV or pseudovirion preparations.
ABOi, ABO-incompatible; BKPyV, BK polyomavirus; GRADE, Grading of Recommendations, Assessment, Development, and Evaluations; LVGR, late viral gene region; mTOR, mammalian target of rapamycin; NCCR, noncoding control region.