Immunosuppression and risk of polyomavirus BK replication

Pham, Phuong‐Thu T.; Reddy, Uttam

doi:10.1038/nrneph.2013.17

Cited by 6 publications

(2 citation statements)

References 12 publications

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“…Current BK management protocols by National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) Guidelines recommend monthly BK testing with plasma nucleic acid testing for the first 3 months, then every three months for the first year and thereafter only if there is unexplained rise in serum creatinine or after an acute rejection episode with subsequent high dose immunosuppression (IS) therapy. Recommendations include decreasing immunosuppression when serum BK is >10,000 copies/mL [24,25]. At our center, we follow a screening regimen described by Koleilat et al [20] screening patients monthly during the first year in an effort to improve early diagnosis [20].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of a Screening and Immunosuppression Protocol for Polyoma BK Viremia after Renal Transplantation

Schuster¹,

Eldor²,

Leutters³

et al. 2017

Glob Surg

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There is currently no treatment consensus with regards to BK Nephropathy (BKN). Thus, balancing minimization of immunosuppression with the attendant risk of acute rejection remains paramount for long-term allograft survival.Between Jan. 1, 2006 and Dec. 31, 2012, 371 adult renal transplants were performed at our center. Immunosuppression consisted of Thymoglobulin induction followed by maintenance therapy with Tacrolimus, Mycophenolate Mofetil (MMF) and either Sirolimus (88%) or prednisone (12%). Serum PCR screening for BK virus was obtained monthly. BK viremia was detected in 66 (18%) recipients (Group A) while the remaining 305 recipients were never detected to have viremia (Group B). Minimizing immunosuppression for Group A recipients occurred in a stepwise fashion and consisted of an immediate 50% reduction in MMF dosing following by complete discontinuation if viremia did not clear within 3 months. No MMF dosing adjustments were made in Group B patients. All recipients were followed longterm for patient survival and graft function and survival.Group A patient survival at 1, 3, and 5 years was 100%, 98.5%, and 97% compared to 99.3%, 98.4%, and 95.4% in Group B. Graft survival at the same time intervals in Group A was 100%, 98.5%, and 93.9% versus 99%, 97.7%, and 92.5% in Group B recipients. Mean serum creatinine, mg/dl, levels at 1, 3, and 5 years in Group A were 1.6, 1.7 and 1.6 compared to 1.5, 1.5, and 1.6 in Group B. Subsequent to MMF dose reduction/elimination, only on Group A patient progressed to BKN (1.5%) and only 2 patients suffered from an episode of acute rejection (3%).This pre-emptive reduction in immunotherapy at the detection of BK viremia was associated with a low rate of progression to BKN and the development of acute rejection. In addition to comparable long-term function.

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Section: Discussionmentioning

confidence: 99%

Long-Term Results of a Screening and Immunosuppression Protocol for Polyoma BK Viremia after Renal Transplantation

Schuster¹,

Eldor²,

Leutters³

et al. 2017

Glob Surg

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“…Recent data suggest that the risk of BKPyV related pathology results from both pre- and post-transplant factors [1–5]. Multiple studies identified tacrolimus (Tac) as a risk factor for developing BKPyV viremia or BKPyVAN [1,2,6–8].…”

Section: Introductionmentioning

confidence: 99%

A delicate balance between rejection and BK polyomavirus associated nephropathy; A retrospective cohort study in renal transplant recipients

et al. 2017

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BackgroundThe immunosuppressive agents mycophenolate acid (MPA) and tacrolimus (Tac) are associated with a higher incidence of BK polyomavirus nephropathy (BKPyVAN).In this observational retrospective cohort study, the frequency of BK polyomavirus (BKPyV) complications over a 24-month period was studied.Methods358 renal transplant recipients (RTR) treated with MPA, with either cyclosporine A (CsA) (CsAM group) or Tac (TacM group) and mostly prednisolone, were included.ResultsIncidence of BKPyV-viremia was not significantly different between the CsAM (n = 42/191) (22.0%) and the TacM (n = 36/167) (21.6%) group. Biopsy proven BKPyVAN occurred more often in the TacM group (6.6%) versus the CsAM group (2.1%) (p = 0.03). Longitudinal data analysis showed a significant earlier decline of viral load in plasma in the CsAM group compared to the TacM group (p = 0.005).The incidence of biopsy proven acute rejection (BPAR) was significantly higher in the CsAM (19.9%) compared to the TacM (10.8%) (p = 0.02) group. Graft loss, estimated glomerular filtration rate and mortality rate did not differ in both treatment groups.ConclusionIn conclusion, this study shows that immunosuppressive treatment with Tac and MPA compared to CsA and MPA is associated with a lower incidence of BPAR, but at the cost of an increased risk of developing BKPyVAN in the first two years post-transplant.

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