Polyomavirus BK replication in de novo kidney transplant patients receiving tacrolimus or cyclosporine: a prospective, randomized, multicenter study

H H Hirsch, F Vincenti, S Friman, M Tuncer, F Citterio, A Wiecek, E H Scheuermann, M Klinger, G Russ, M D Pescovitz, H Prestele, H H Hirsch, F Vincenti, S Friman, M Tuncer, F Citterio, A Wiecek, E H Scheuermann, M Klinger, G Russ, M D Pescovitz, H Prestele

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 log(10) 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.

© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1. BKV viruria and viremia after…
Figure 1. BKV viruria and viremia after kidney transplantation
(A) Cumulative new-onset BKV replication posttransplant; (B) point prevalence at the times of testing (patient sample number below); (C) viral load in new-onset BKV viruria posttransplant; (D) viral load in new-onset BKV viremia postransplant
Figure 2. BKV viruria and viremia rates…
Figure 2. BKV viruria and viremia rates according to the treatment arm
(A) BKV viruria; (B) BKV viruria above 7 log10 geq/mL (high-level viruria); (C) urine BKV loads in viruric patients; (D) BKV viremia; (E) BKV viremia above 4 log10 geq/mL (high-level viremia); (F) plasma BKV loads in viremic patients.
Figure 3
Figure 3
Mycophenolate dosing over time posttransplant by calcineurin inhibitor.

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Source: PubMed

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