title: Management and outcome of BK viremia in renal transplant recipients: a prospective single-center study.
abstract: BACKGROUND
  BK viremia can lead to nephritis, which can progress to irreversible kidney transplant failure. Our prospective study provides management and outcome of BK viremia in renal transplant recipients.
  
  
  METHODS
  Two hundred forty de novo kidney-only recipients were enrolled from July 2007 to July 2010 and followed for 1 year. Standard immunosuppression with Thymoglobulin/interleukin 2 receptor blocker and mycophenolate mofetil/tacrolimus (Tac)/prednisone was employed. Quantitative BK virus (BKV) DNA surveillance in plasma/urine was performed at 1, 3, 6, 12, and 24 months after transplantation. Patients with significant viremia (defined as ≥10,000 viral copies/mL) underwent renal biopsy and treated with 30% to 50% reduction in doses of both mycophenolate mofetil and Tac without antiviral therapy. The target 12-hr Tac trough levels were lowered to 4 to 6 ng/mL in the significant viremia group, whereas the target levels remained unchanged at 5 to 8 ng/mL for all other groups.
  
  
  RESULTS
  Sixty-five patients (27%) developed BK viremia; 28 (12%) of whom had significant viremia. A total of five (21%) of the 23 (of 28) patients who underwent biopsy presented with subclinical BKV nephritis. The mean plasma BKV DNA declined by 98% (range, 76%-100%) at 1 year after peak viremia. Acute cellular rejection seen in four (14%) of 28 patients, responded to bolus steroids. There was no decline in estimated glomerular filtration rate over time from 1 month after transplantation to 1 year after peak viremia (P=0.57).
  
  
  CONCLUSIONS
  Reduction in immunosuppression alone resulted in the successful resolution of viremia with preservation of renal function and prevention of clinical BKV nephritis and graft loss.
authors.affiliation: Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Puneet
authors.initials: P
authors.lastname: Sood
authors.forename: Shamila
authors.initials: S
authors.lastname: Senanayake
authors.forename: Kumar
authors.initials: K
authors.lastname: Sujeet
authors.forename: Radhika
authors.initials: R
authors.lastname: Medipalli
authors.forename: Yong R
authors.initials: YR
authors.lastname: Zhu
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Johnson
authors.forename: Sundaram
authors.initials: S
authors.lastname: Hariharan
mesh_terms: D000328:Adult; D000368:Aged; D001739:BK Virus / Q000302:isolation & purification*; D001706:Biopsy; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D009393:Nephritis / Q000517:prevention & control; D027601:Polyomavirus Infections / Q000188:drug therapy*; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D016559:Tacrolimus / Q000008:administration & dosage; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000188:drug therapy*; D019562:Viral Load; D014766:Viremia / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology
chemical_list: D009173:Mycophenolic Acid; D016559:Tacrolimus