Comparison of BK virus nephropathy risk between double-J-stent with anti-reflux mechanism and standart double-J-stent: single-center experience

Year 2022, Volume: 5 Issue: 5, 1456 - 1460, 25.09.2022

Nurettin Ay

https://doi.org/10.32322/jhsm.1141455

Abstract

Aim: Ureteral stend use is a risk factor for BK nephropathy (BKVN). In 2015, we compared the patients with anti-reflux mechanism DJS (ARD-DJS) and those used standard DJS (st-DJS) in terms of BKV and BKVN frequency in 90 kidney transplant patients in two centers. With the increase in the number of our patients over time and lengthening of the follow-up duration, we needed to re-evaluate the data in one center.
Material and Method: We retrospectively evaluated 211 patients who underwent kidney transplantation at Gazi Yaşargil Training and Research Hospital between September 2012 and September 2019. The following parameters were recorded, demographic data, immunosuppression protocols, presence of rejection, graft loss, plasma BKV levels, and presence of BKVN.
Median and IQR follow-up time for ARD-DJS and St-DJS patients was 72 months (62,5-80,3 months) and 27,8 months (17,4-39,6 months) respectively.
Results: Thirteen patients (6,1%) had BKV viremia. BKVN was revealed by kidney biopsy in 3 of 13 patients. However, graft loss due to BKVN was observed in only one patient. ARD-DJS was used in 4 of these cases and standard DJS was used in 9 of these cases. Patients in whom BKV revealed in the first 3 months were compared in the aspect of DJS technique, BKV was significantly less observed in the ARD-DJS group (ARD-DJS: 2 patients; St-DJS:9 patients), (p=0,046).
Conclusion: In our study, BKV was observed less in patients with ARD-DJS that were clinically significant but not statistically significant. Therefore, prospective randomized studies with high patient numbers are needed to determine the effectiveness of ARD-DJS.

Keywords

BKV, kidney transplantation, ureteral stend

References

• Mengel M, Marwedel M, Radermacher J, et al. Incidence of polyomavirus-nephropathy in renal allografts: influence of modern immunosuppressive drugs. Nephrol Dial Transplant 2003; 18: 1190-6.
• Thomas A, Dropulic L, Rahman M, Geetha D. Ureteral stents: a novel risk factor for polyomavirus nephropathy. Transplantation 2007; 84: 433-6.
• Pham PT, Schaenman J, Pham PC. BK virus infection following kidney transplantation: an overview of risk factors, screening strategies, and therapeutic interventions. Curr Opin Organ Transplant 2014; 19: 401-12.
• Balba GP, Javaid B, Timpone Jr JG. BK polyomavirus infection in the renal transplant recipient. Infect Dis Clin North Am 2013; 27: 271-83.
• Gralla J, Huskey J, Wiseman AC. Trends in immune function assay (ImmuKnow; Cylex™) results in the first year post-transplant and relationship to BK virus infection. Nephrol Dial Transplant 2012; 27: 2565-70.
• Bohl DL, Brennan DC. BK virus nephropathy and kidney transplantation. Clin J Am Soc Nephrol 2007; 1: 36-46.
• FE Yeo, CM Yuan, SJ Swanson et al. The prevalence of BK polyomavirus infec tion in outpatient kidney transplant recipients followed in a single center. Clin Transplant 2008; 22: 532-41.
• Hirsch HH, Randhawa P, AST Infectious Diseases Community of Practice. BK polyomavirus in solid organ transplantation. Am J Transplant 2013: 179–88.
• Schold JD, Rehman S, Kayle LK, Magliocca J, Srinivas TR, Meier- Kriesche HU. Treatment for BK virus: Incidence, risk factors and outcomes for kidney transplant recipients in the United States. Transpl Int 2009; 22: 626–34.
• Hirsch HH, Babel N, Comoli P, et al. ESCMID Study Group of Infection in Compromised Hosts: European perspective on human polyomavirus infection, replication and disease in solid organ transplantation. Clin Microbiol Infect 2014; 7: 74–88.
• Atencio IA, Shadan FF, Zhou XJ, Vaziri ND, Villarreal LP. Adult mouse kidneys become per­missive to acute polyomavirus infection and reactivate persistent infections in response to cellular damage and regeneration. J Virol 1993; 67: 1424-32.
• Atencio IA, Villarreal LP. Polyomavirus repli­cates in differentiating but not in proliferating tubules of adult mouse polycystic kidneys. Virology 1994; 201: 26-35.
• Ay N, Bahadır MV, Anıl M, et al. Comparison of anti-reflux mechanism between double-J-stent and standart double-J-stent use for risk of BK nephropathy and urinary tract infection in kidney transplantation. Int J Clin Exp Med 2015; 8: 16340-5.
• Mosli HA, Farsi HM, al-Zimaity MF, Saleh TR, al-Zamzami MM. Vesicoureteral reflux in pa­tients with double pigtail stents. J Urol 1991; 146: 966-9.
• Kayle L, Zendejas I, Schain D, Magliocca J. Ureteral stent placement and BK viremia in kidney transplant recipients. Transpl Infect Dis 2013; 15: 202-7.
• Maliakkal JG, Brennan DC, Goss C, et al. Ureteral stent placement and ımmediate graft function are associated with ıncreased risk of BK viremia in the first year after kidney transplantation. Transpl Int 2017; 30: 153-61.
• Martinez Moreno AI, Garcia JG, Mari VRi, Ayala EP. Prevalence of BK virus in renal transplant at a single center: experience with our ureteral reimplantation surgical technique. Exp Clin Transplant 2020; 18: 458-62.
• Gupta P, Gupta A, Bhalla AK, et al. BK virus nephropathy in living donor renal allograft recipients: an observational study from a large transplant center in India. Saudi J Kidney Dis Transpl 2018; 29: 1366-70.
• Pucar D, Klein K, Corler J, Williams HT. BK nephritis and venous thrombosis in renal transplant recipient detected by 111 in leukocyte imaging. Clin Nucl Med 2015; 40: 382-5.