title: BK-virus and the impact of pre-emptive immunosuppression reduction: 5-year results.
abstract: A 1-year, single-center, randomized trial demonstrated that the calcineurin inhibitor or adjuvant immunosuppression, independently, does not affect BK-viruria or viremia and that monitoring and pre-emptive withdrawal of immunosuppression was associated with resolution of BK-viremia and absence of clinical BK-nephropathy without acute rejection or graft loss. A retrospective 5-year review of this trial was conducted. In cases of BK viremia, the antimetabolite was withdrawn and for sustained viremia, the calcineurin inhibitor was minimized. Five-year follow-up was available on 97% of patients. Overall 5-year patient survival was 91% and graft survival was 84%. There were no differences in patient-survival by immunosuppressive regimen or presence of BK-viremia. Immunosuppression and viremia did not influence graft survival. Acute rejection occurred in 12% by 5-years after transplant, was less common with tacrolimus versus cyclosporine (9% vs. 18%; p = 0.082), and was lowest with the tacrolimus-azathioprine regimen (5%, p = 0.127). Tacrolimus was associated with better renal function at 5-years (eGFR 63 FK vs. 52 CsA mL/min, p = 0.001). Minimization of immunosuppression upon detection of BK-viremia was associated with excellent graft survival at 5-years, low rejection rates and excellent renal function. It is a safe, short and long-term strategy that resulted in freedom from clinically evident BK-virus nephropathy.
authors.affiliation: Department of Pharmacy Practice, University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Hardinger
authors.forename: M J
authors.initials: MJ
authors.lastname: Koch
authors.forename: D J
authors.initials: DJ
authors.lastname: Bohl
authors.forename: G A
authors.initials: GA
authors.lastname: Storch
authors.forename: D C
authors.initials: DC
authors.lastname: Brennan
mesh_terms: D001379:Azathioprine / Q000627:therapeutic use; D001739:BK Virus / Q000187:drug effects*; D016572:Cyclosporine / Q000627:therapeutic use; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007674:Kidney Diseases; D007677:Kidney Function Tests; D016559:Tacrolimus / Q000627:therapeutic use; D014766:Viremia
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine; D016559:Tacrolimus