title: Polyomavirus BK replication in de novo kidney transplant patients receiving tacrolimus or cyclosporine: a prospective, randomized, multicenter study.
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.
authors.affiliation: Transplantation and Clinical Virology, Department Biomedicine-Building Petersplatz, University of Basel, Switzerland. hans.hirsch@unibas.ch
authors.forename: H H
authors.initials: HH
authors.lastname: Hirsch
authors.forename: F
authors.initials: F
authors.lastname: Vincenti
authors.forename: S
authors.initials: S
authors.lastname: Friman
authors.forename: M
authors.initials: M
authors.lastname: Tuncer
authors.forename: F
authors.initials: F
authors.lastname: Citterio
authors.forename: A
authors.initials: A
authors.lastname: Wiecek
authors.forename: E H
authors.initials: EH
authors.lastname: Scheuermann
authors.forename: M
authors.initials: M
authors.lastname: Klinger
authors.forename: G
authors.initials: G
authors.lastname: Russ
authors.forename: M D
authors.initials: MD
authors.lastname: Pescovitz
authors.forename: H
authors.initials: H
authors.lastname: Prestele
mesh_terms: D000328:Adult; D001739:BK Virus / Q000502:physiology*; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D014779:Virus Replication
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus