title: Incidence of BK with tacrolimus versus cyclosporine and impact of preemptive immunosuppression reduction.
abstract: Our purposes were to determine the incidence of BK viruria, viremia or nephropathy with tacrolimus (FK506) versus cyclosporine (CyA) and whether intensive monitoring and discontinuation of mycophenolate (MMF) or azathioprine (AZA), upon detection of BK viremia, could prevent BK nephropathy. We randomized 200 adult renal transplant recipients to FK506 (n = 134) or CyA (n = 66). Urine and blood were collected weekly for 16 weeks and at months 5, 6, 9 and 12 and analyzed for BK by polymerase chain reaction (PCR). By 1 year, 70 patients (35%) developed viruria and 23 (11.5%) viremia; neither were affected independently by FK506, CyA, MMF or AZA. Viruria was highest with FK506-MMF (46%) and lowest with CyA-MMF (13%), p = 0.005. Viruria >/= 9.5 log(10) copies/mL was associated with a 3-fold increased risk of viremia and a 13-fold increased risk of sustained viremia. After reduction of immunosuppression, viremia resolved in 95%, without increased acute rejection, allograft dysfunction or graft loss. No BK nephropathy was observed. Choice of calcineurin inhibitor or adjuvant immunosuppression, independently, did not affect BK viruria or viremia. Viruria was highest with FK506-MMF and lowest with CyA-MMF. Monitoring and preemptive withdrawal of immunosuppression were associated with resolution of viremia and absence of BK nephropathy without acute rejection or graft loss.
authors.affiliation: Washington University School of Medicine, Department of Internal Medicine, St. Louis, Missouri, USA. brennand@msnotes.wustl.edu
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Irfan
authors.initials: I
authors.lastname: Agha
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Bohl
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Karen L
authors.initials: KL
authors.lastname: Hardinger
authors.forename: Mark
authors.initials: M
authors.lastname: Lockwood
authors.forename: Stephanie
authors.initials: S
authors.lastname: Torrence
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schuessler
authors.forename: Tiffany
authors.initials: T
authors.lastname: Roby
authors.forename: Monique
authors.initials: M
authors.lastname: Gaudreault-Keener
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Storch
mesh_terms: D001739:BK Virus / Q000187:drug effects*; D016572:Cyclosporine / Q000494:pharmacology*; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D027601:Polyomavirus Infections / Q000517:prevention & control*; D012307:Risk Factors; D016559:Tacrolimus / Q000494:pharmacology*; D013997:Time Factors; D014412:Tumor Virus Infections / Q000517:prevention & control*; D014766:Viremia
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus