Polyomavirus BK Replication in De Novo Kidney Transplant Patients Receiving Tacrolimus or Cyclosporine: A Prospective,Randomized, Multicenter Study |
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| Authors: | F. Vincenti S. Friman M. Tuncer F. Citterio A. Wiecek E. H. Scheuermann M. Klinger G. Russ M. D. Pescovitz H. Prestele |
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| Affiliation: | 1. University of California San Francisco, Kidney Transplant Service, , San Francisco, CA;2. Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, , Gothenburg, Sweden;3. MedicalPark Hospital, Organ Transplant Center, , Antalya, Turkey;4. Division of Organ Transplantation, Department of Surgery, Catholic University of the Sacred Heart, , Rome, Italy;5. Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, , Katowice, Poland;6. Department of Nephrology, University Hospital, , Frankfurt am Main, Germany;7. Department of Nephrology and Transplantation Medicine, Medical University, , Wroclaw, Poland;8. The Queen Elizabeth Hospital, , Woodwille, Australia;9. Departments of Surgery and Microbiology/Immunology, Indiana University, , Indianapolis, IN;10. Novartis Pharma AG, , Basel, Switzerland |
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| Abstract: | ![]()
Polyomavirus BK (BKV)‐associated nephropathy causes premature kidney transplant (KT) failure. BKV viruria and viremia are biomarkers of disease progression, but associated risk factors are controversial. A total of 682 KT patients receiving basiliximab, mycophenolic acid (MPA), corticosteroids were randomized 1:1 to cyclosporine (CsA) or tacrolimus (Tac). Risk factors were analyzed in 629 (92.2%) patients having at least 2 BKV measurements until month 12 posttransplant. Univariate analysis associated CsA‐MPA with lower rates of viremia than Tac‐MPA at month 6 (10.6% vs. 16.3%, p = 0.048) and 12 (4.8% vs. 12.1%, p = 0.004) and lower plasma BKV loads at month 12 (3.9 vs. 5.1 log10 copies/mL; p = 0.028). In multivariate models, CsA‐MPA remained associated with less viremia than Tac‐MPA at month 6 (OR 0.60; 95% CI 0.36–0.99) and month 12 (OR 0.33; 95% CI 0.16–0.68). Viremia at month 6 was also independently associated with higher steroid exposure until month 3 (OR 1.19 per 1 g), and with male gender (OR 2.49) and recipient age (OR 1.14 per 10 years) at month 12. The data suggest a dynamic risk factor evolution of BKV viremia consisting of higher corticosteroids until month 3, Tac‐MPA compared to CsA‐MPA at month 6 and Tac‐MPA, older age, male gender at month 12 posttransplant. |
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| Keywords: | BK virus cyclosporine immunosuppression polyomavirus risk factor steroids tacrolimus transplantation |
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