Unveiling Donor-Derived BKPyV DNAemia Through Analysis of Contralateral Kidney Transplant Recipients

Background BK Polyomavirus(BKPyV) infection is of notable concern in kidney transplant recipients, as it can cause BKPyV-associated nephropathy (BKPyVAN). Currently, there is no effective treatment for BKPyV infection, underscoring the need for preventive strategies. There is emerging evidence that donor-derived BKPyV plays a role in the development of BKPyV DNAemia. To further explore this hypothesis, we conducted a retrospective, multi-center cohort study to evaluate the risk of developing BKPyV DNAemia in kidney recipient pairs sharing the same donor. Methods At the Leiden University Medical Center, we identified recipients of deceased donor kidneys (2011–2021) with and without BKPyV DNAemia within the first year post-transplant. Contralateral kidney recipients were identified through national registries. Cox regression assessed the risk of BKPyV DNAemia when the contralateral recipient was affected. Results Among 117 recipient pairs, BKPyV DNAemia was more frequent when the contralateral recipient was affected (28.8%[15/52]),compared with pairs in which the contralateral recipient remained unaffected (10.8%[7/65],p=0.013). Multivariate analysis confirmed this increased risk (HR4.2,95%CI:1.5–11.9;p=0.007). Conclusion This study shows a significantly increased risk of BKPyV DNAemia in recipients of deceased donor kidneys when the contralateral kidney recipient develops BKPyV DNAemia. These findings highlight the influence of donor-derived factors in BKPyV transmission in kidney transplantation.