A systematic literature review and meta-analysis evaluated modifiable risk factors for the development of BK polyoma virus-associated complications.
Eder, M., et al.Kidney Int. 2025 Oct;108(4):669-685.
Aims
This study aimed to determine modifiable risk factors associated with BK polyomavirus (BKPyV)-related complications in renal transplant patients.
Interventions
Medline, Embase and the Cochrane Register of Controlled Trials were searched for literature. Studies were screened by two reviewers. The Quality in Prognostic Factor Studies tool was used to assess the methodological quality of the included studies.
Participants
165 publications were included in this study.
Outcomes
The main outcome of interest was risk factors for BKPyV endpoints: biopsy-proven BK polyomavirus–associated nephropathy (BKPyVAN), presumptive BKPyVAN and any BKPyV-DNAemia.
Follow-up
N/A
CET Conclusions
The occurrence of BK polyomavirus (BKPyV) infection following kidney transplant is associated with several clinical factors. This meta-analysis synthesised the available data to determine the magnitude of effect of specific modifiable risk factors, including immunosuppression regimen, ABO incompatible (ABOi) transplant, and ureteral stenting. The outcome measures included rates of biopsy proven BKPyV-associated nephropathy, BKPyV DNAemia, and BKPyV treatment initiation. A validated tool was used to assess bias in the selected studies. 165 studies (n= 197,029) were included. The results showed what is already well established – more aggressive immunosuppression results in higher rates of BKPyV infection. Because of high heterogeneity between the included studies, comparison between specific immunosuppression agents could not be made, despite the high overall patient number. 29 studies were reported as having a high risk of bias. However, with only 2 of the 165 included studies being randomised trials, this is likely to be an underestimation. Lastly, most of the analysed factors (e.g. immunosuppression choice, ABOi transplant) are dictated by patient factors and are thus largely not modifiable, which the authors indirectly acknowledge in their conclusions. The findings of this meta-analysis thus provide little new insight into strategies to reduce the rates of BKPyV infection in kidney transplant patients.
Trial registration
N/A