Reducing Immunosuppression Preserves Allograft Function in Presumptive and Definitive Polyomavirus-Associated Nephropathy

Schaub, Stefan; Hirsch, Hans H.; Dickenmann, Michael; Steiger, Jürg; Mihatsch, Michael J.; Hopfer, Helmut; Mayr, Michael

doi:10.1111/j.1600-6143.2010.03310.x

Cited by 228 publications

(257 citation statements)

References 39 publications

Supporting

Mentioning

223

Contrasting

Unclassified

Order By: Relevance

“…In those and other studies, viremia cleared in 92%e95% of patients, with a mean time to clearance of 54 days [18,19]. In contrast, rejection rates of up to 30% have been reported with reduction in immunosuppression alone, and allograft loss of 35%e50% despite reduction in total immunosuppression [20,21].…”

Section: Treatmentmentioning

confidence: 66%

See 1 more Smart Citation

Late-Onset BK Viral Nephropathy in a Kidney Transplant Recipient

Mathew

Holanda

Figanbaum

et al. 2014

Transplantation Proceedings

View full text Add to dashboard Cite

Section: Treatmentmentioning

confidence: 66%

“…In early BK viral nephropathy, reduction of immunosuppression may be sufficient, 3-year graft survivals of 88%e100% being reported [17,18]. In those and other studies, viremia cleared in 92%e95% of patients, with a mean time to clearance of 54 days [18,19].…”

Section: Treatmentmentioning

confidence: 75%

Late-Onset BK Viral Nephropathy in a Kidney Transplant Recipient

Mathew

Holanda

Figanbaum

et al. 2014

Transplantation Proceedings

View full text Add to dashboard Cite

“…Our immunosuppression reduction strategy consisted of minimizing exposure to MMF, while making efforts to maintain Tacrolimus dose stable. However, center practices also vary, as other studies suggest that reduction of either Tac or antiproliferative agents have similar overall viral load reduction to MMF reduction despite stronger association between Tacrolimus and BK viremia [27].…”

Section: Discussionmentioning

confidence: 93%

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

Schuster¹,

Eldor²,

Leutters³

et al. 2017

Glob Surg

View full text Add to dashboard Cite

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.

show abstract

“…Incidence of BKV-associated nephropathy among patients with significant BK viremia ranges between 16% and 50% in some series, with progression to allograft loss in 0.7-16% of patients (107,108,111). In the United States, the incidence of BKV-associated nephropathy at 2 years after transplant appeared to increase steadily from 1.5% in 2003 to 6.4% in 2006 (112), although the implementation of universal screening and preemptive reduction of immunosuppression in the majority of transplant centers in recent years has reduced this incidence (30). Consequently, BKV disease (along with HCV infection in liver transplant recipients) may well represent the most common infectious complication directly associated with allograft dysfunction in SOT recipients.…”

Section: Type Of Organ Transplantmentioning

confidence: 99%

“…A chronic inflammatory process due to upregulated proinflammatory cytokines causing cell detachment in human pulmonary epithelial cell lines has been suggested as a possible mechanism of damage in the development of BOS by Aspergillus (28). Other mechanisms contributing to impaired allograft function and survival include sepsisassociated ischemia due to hemodynamic instability (29), acute rejection due to minimization of immunosuppression for clearance of viral infections (30) and direct drug toxicity (e.g. foscarnet or aminoglycoside-associated renal toxicity) (31).…”

Section: Nonimmunological Factorsmentioning

confidence: 99%

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation

Martín-Gandul

Mueller

Pascual

et al. 2015

American Journal of Transplantation

133

103

View full text Add to dashboard Cite

Infectious diseases after solid organ transplantation (SOT) are a significant cause of morbidity and reduced allograft and patient survival; however, the influence of infection on the development of chronic allograft dysfunction has not been completely delineated. Some viral infections appear to affect allograft function by both inducing direct tissue damage and immunologically related injury, including acute rejection. In particular, this has been observed for cytomegalovirus (CMV) infection in all SOT recipients and for BK virus infection in kidney transplant recipients, for community-acquired respiratory viruses in lung transplant recipients, and for hepatitis C virus in liver transplant recipients. The impact of bacterial and fungal infections is less clear, but bacterial urinary tract infections and respiratory tract colonization by Pseudomonas aeruginosa and Aspergillus spp appear to be correlated with higher rates of chronic allograft dysfunction in kidney and lung transplant recipients, respectively. Evidence supports the beneficial effects of the use of antiviral prophylaxis for CMV in improving allograft function and survival in SOT recipients. Nevertheless, there is still a need for prospective interventional trials assessing the potential effects of preventive and therapeutic strategies against bacterial and fungal infection for reducing or delaying the development of chronic allograft dysfunction.

show abstract

Reducing Immunosuppression Preserves Allograft Function in Presumptive and Definitive Polyomavirus-Associated Nephropathy

Cited by 228 publications

References 39 publications

Late-Onset BK Viral Nephropathy in a Kidney Transplant Recipient

Late-Onset BK Viral Nephropathy in a Kidney Transplant Recipient

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

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation

Contact Info

Product

Resources

About