Kidney transplant (KTx) recipients require life-long immunosuppressive therapy to prevent immunological rejection and transplant loss. One of the complications of immunosuppression is increased risk of viral and other opportunistic infections. During the first post-transplant year, 10-15% of KTx recipients develop reactivation of the polyomavirus BK virus (BKV) which is detectable in blood as a viremia. If BK viremia persists and escalates, it is associated with a damaging inflammatory nephropathy that can result in severe transplant injury. As no effective anti-viral therapy is available for BKV, current clinical practice involves regular monitoring of new KTx recipients for BK viremia and reduction in immunosuppressive therapy if it is detected in order to promote anti-viral immunity. Whether reduced immunosuppression for BK viremia results in increased long-term risk of reduced KTx function or higher rates of KTx rejection is not clearly understood. Thus, this project aims to determine the influence of immunosuppressive therapy reduction for BK viremia on the long-term outcomes of KTx recipients who began their post-transplant follow-up at the Galway University Hospitals Nephrology clinics between 2012 and 2020. It is hypothesised that immunosuppression reduction for BK viremia during the first year after transplantation is associated with inferior long-term transplant function. The study design will involve comparing KTx recipients that developed BK viremia (BKV group) with a matched control group that did not. Through retrospective clinical data collection from electronic medical records of eligible KTx recipients and appropriate descriptive and comparative statistical analyses, the project will allow the student to: (a) Describe the frequency and immunosuppression management of BK viremia among new KTx recipients first attending the GUH Nephrology Clinics between 2012 and 2020. (b) Compare KTx functional trends and outcomes among KTx recipients with and without a diagnosis of BK viremia during the first post-transplant year.
