WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Laith Afeef Ahmed Al-Doury*, 2Dr. Safa Ezzedin Almukhtar (Professor)

ABSTRACT

Background: BK polyomavirus reactivation after kidney transplantation can lead to viremia and BK virus nephropathy (BKVN). Evidence from different centers varies by immunosuppression and screening intensity. This single-center study from Erbil evaluated the incidence and timing of BK viruria and viremia during the first post-transplant year under a uniform immunosuppression protocol and scheduled surveillance. Methods: A cohort of 100 kidney transplant recipients aged 16-65 years was followed from June 1, 2023 to June 1, 2025. All grafts were from living donors. Induction immunosuppression was antithymocyte globulin in all recipients; maintenance comprised mycophenolate mofetil and prednisolone plus a calcineurin inhibitor (cyclosporine in 75% and tacrolimus in 25%). Urine and plasma BK PCR were obtained at 3, 6, and 12 months. Primary outcomes were the incidence of viruria and viremia at each timepoint and their 12-month cumulative incidence. Secondary summaries included overlap of urine/plasma positivity, subgroup comparisons by calcineurin inhibitor, sex, and transplant number. Results: BK viruria was detected in 41.7% at 3 months (40/96), 34.3% at 6 months (34/99), and 22.4% at 12 months (22/98). BK viremia occurred in 15.6% at 3 months (15/96), 28.3% at 6 months (28/99), and 12.2% at 12 months (12/98). Cumulative 12-month incidence was 68% for viruria and 47% for viremia. At first viremia, 42.6% had concurrent viruria and 31.9% had prior viruria. Any-time viruria was 66.7% with cyclosporine and 72.0% with tacrolimus; any-time viremia was 48.0% and 44.0%, respectively, with no large differences by sex or transplant number. Pre-emptive immunosuppression reduction was undertaken in 83% of viremic patients. BKVN occurred in 3%, acute rejection in 8%, and mean eGFR at 12 months was 66.3 mL/min/1.73 m²; eGFR was lower among patients with any viremia (63.1 vs 69.0 mL/min/1.73 m²). Conclusions: These findings support maintaining the 3-6-12-month screening cadence, using early viruria to anticipate plasma replication, and promptly reducing maintenance immunosuppression upon confirmed viremia.