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Intravenous immunoglobulin as a preventive strategy against BK virus viremia and BKV-associated nephropathy in kidney transplant recipients—Results from a proof-of-concept study

https://doi.org/10.1111/ajt.16233Get rights and content
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BK virus (BKV) replication occurs frequently in kidney transplant recipients (KTR), potentially leading to BKV-associated nephropathy (BKVAN) and graft loss. Patients with high titers of BKV-neutralizing antibodies (NAbs) are protected against BKV replication, and intravenous immunoglobulin (IVIg) infusion can increase NAb titers. We investigated whether early IVIg administration prevents BKV replication in patients with low NAb titers (<4 log10 against the BKV-specific genotype). Based on NAb titers on the day of transplantation, KTR followed in the Strasbourg University Hospital (n = 174) were retrospectively divided into the following 3 risk categories for BKV replication: (1) patients with low NAb titers (“high-risk”) who received IVIg for the first 3 posttransplant months (n = 44), (2) patients with low NAb titers (“high-risk”) who did not undergo IVIg treatment (n = 41), and (3) patients with high NAb titers (“low-risk”) who did not receive IVIg (n = 89). At 12 posttransplant months, the incidence of BKV viremia in the high-risk group treated with IVIg (6.8%) was similar to that observed in the low-risk group (10.1%) and markedly lower than that of the untreated high-risk group (36.6%; P < .001). Similar results were observed with regard to BKVAN. We conclude that IVIg may be a valuable strategy for preventing BKV replication.

KEYWORDS

antibiotic: antiviral
clinical research/practice
complication: infectious
infection and infectious agents – viral: BK/JC/polyoma
infectious disease
kidney transplantation/nephrology

Abbreviations

AMR
antibody-mediated rejection
AUC
area under the concentration-time curve
BKV
BK virus
BKVAN
BKV-associated nephropathy
Day 0
day of transplantation
DSA
donor-specific antibodies
IgG
immunoglobulin G
IVIg
intravenous immunoglobulin
KT
kidney transplantation
KTR
kidney transplant recipients
MMF
mycophenolate mofetil
mTOR
mammalian target of rapamycin
NAb
neutralizing antibodies
PRA
panel reactive antibody
SD
standard deviation
SID
secondary immunodeficiency

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[Correction added on 4 December, 2020, after first online publication: In the abstract, “from developing” has been removed in the sentence: “We investigated whether early IVIg administration prevents BKV replication in patients with low NAb titers (<4 log10 against the BKV-specific genotype); The word “intravenous immunoglobulins” has been corrected to “intravenous immunoglobulin” in all occurrence]