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HLA MISMATCHING INCREASES THE INCIDENCE OF BK VIRAL NEPHRITIS AFTER KIDNEY TRANSPLANTATION.
Yehia Awadalla MD, PhD , Parmjeet Rhandawa MD , Kris Ruppert PhD , Adriana Zeevi PhD and Rene J. Duquesnoy, PhD . Pittsburgh PA, University of Pittsburgh Medical Center, 15261, Division of Transplantation Pathology .
Recent studies have demonstrated that approximately 5% of kidney transplant recipients develop BK viral nephritis and about one-half of them lose their grafts. The diagnosis is often made during the first year post-transplant and the pathological manifestations include viral nuclear inclusion bodies in damaged tubular epithelial cells that are surrounded by interstitial infiltrates of lymphocytes and plasma cells. Since 70% of adults are serologically positive for BK virus, there is a significant potential of viral latency in kidney grafts.
We have analyzed the effect of HLA matching in 68 renal transplant recipients who developed BK virus nephritis and a comparable control group of 89 patients who did not get the disease. Univariate analysis of data showed transplants with BK nephritis came from donors with more antigen mismatches at HLA-A (p= 0.007), HLA-B (p=0.03), and especially HLA-DR (p=0.0004) than the control cases. BK nephritis was also associated with the larger number of acute rejection episodes (p=0.0001). Multivariate regression analysis showed a strong correlation between the development of BK nephritis and the number of A, B, DR mismatches and the number of acute rejection episodes (P<0.0001). The Odds Ratios were 2.6 and 4.6, respectively. There was no significant effect of donor or recipient gender or age, recipient race, deceased or live donor status, graft number, cold ischemia time and diabetic status. Also, we could not identify any patient HLA antigen associated with an increased incidence of BK virus nephritis.
Although previous studies have shown that virus-associated immune mechanisms of graft failure are more prevalent in HLA-matched transplants, these findings suggest HLA mismatching increases the risk of post-transplant BK nephritis.