{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:47:40Z","timestamp":1787014060275,"version":"build-2736575974"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immunosuppression reduction for BK polyoma virus (BKV) must be balanced against risk of adverse alloimmune outcomes. We sought to characterize risk of alloimmune events after BKV within context of HLA\u2010DR\/DQ molecular mismatch (mMM) risk score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center study evaluated 460 kidney transplant patients on tacrolimus\u2010mycophenolate\u2010prednisone from 2010\u20102021. BKV status was classified at 6\u2010months post\u2010transplant as \u201cBKV\u201d or \u201cno BKV\u201d in landmark analysis. Primary outcome was T\u2010cell mediated rejection (TCMR). Secondary outcomes included all\u2010cause graft failure (ACGF), death\u2010censored graft failure (DCGF), de novo donor specific antibody (dnDSA), and antibody\u2010mediated rejection (ABMR). Predictors of outcomes were assessed in Cox proportional hazards models including BKV status and alloimmune risk defined by recipient age and molecular mismatch (RAMM) groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At 6\u2010months post\u2010transplant, 72 patients had BKV and 388 had no BKV. TCMR occurred in 86 recipients, including 27.8% with BKV and 17% with no BKV (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.05). TCMR risk was increased in recipients with BKV (HR 1.90, (95% CI 1.14, 3.17);\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.01) and high vs. low\u2010risk RAMM group risk (HR 2.26 (95% CI 1.02, 4.98);\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.02) in multivariable analyses; but not HLA serological MM in sensitivity analysis. Recipients with BKV experienced increased dnDSA in univariable analysis, and there was no association with ABMR, DCGF, or ACGF.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Recipients with BKV had increased risk of TCMR independent of induction immunosuppression and conventional alloimmune risk measures. Recipients with high\u2010risk RAMM experienced increased TCMR risk. Future studies on optimizing immunosuppression for BKV should explore nuanced risk stratification and may consider novel measures of alloimmune risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.15329","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T08:24:35Z","timestamp":1715243075000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Association of BKV viremia and nephropathy with adverse alloimmune outcomes in kidney transplant recipients"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8040-7908","authenticated-orcid":false,"given":"Christie","family":"Rampersad","sequence":"first","affiliation":[{"name":"University Health Network University of Toronto  Toronto Ontario Canada"},{"name":"Transplant Manitoba Adult Kidney Program  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1006-3545","authenticated-orcid":false,"given":"Chris","family":"Wiebe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"},{"name":"Transplant Manitoba Adult Kidney Program  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Balshaw","sequence":"additional","affiliation":[{"name":"George and Fay Yee Centre for Healthcare Innovation  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Bullard","sequence":"additional","affiliation":[{"name":"Cadham Provincial Laboratory  Winnipeg Manitoba Canada"},{"name":"Department of Pediatrics University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian W.","family":"Gibson","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Manitoba  Winnipeg Manitoba Canada"},{"name":"Diagnostic Services of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8940-5458","authenticated-orcid":false,"given":"Aaron","family":"Trachtenberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"},{"name":"Transplant Manitoba Adult Kidney Program  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"},{"name":"Transplant Manitoba Adult Kidney Program  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armelle Perez Cortes","family":"Villalobos","sequence":"additional","affiliation":[{"name":"University Health Network University of Toronto  Toronto Ontario Canada"},{"name":"Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Karpinski","sequence":"additional","affiliation":[{"name":"University Health Network University of Toronto  Toronto Ontario Canada"},{"name":"Department of Internal Medicine University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aviva","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Birk","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Manitoba  Winnipeg Manitoba 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