title: Everolimus leads to a lower risk of BKV viremia than mycophenolic acid in de novo renal transplantation patients: a single-center experience.
abstract: BACKGROUND
  There are limited published data concerning the effects of different immunosuppressive regimens on the development of polyomavirus (BKV) viremia. We examined the risk of developing BKV viremia in kidney transplant recipients receiving everolimus (EVR) or mycophenolic acid (MPA) as maintenance therapy.
  
  
  METHODS
  We observationally analyzed 296 patients who underwent renal transplantation at our center between 2005 and 2010: 58 were treated with EVR and low-dose cyclosporine (LD-CyA) (group 1) and 238 with MPA and standard-dose CyA (group 2). All of the patients received induction therapy with basiliximab and maintenance steroids. BKV viremia (a whole-blood viral load of >850 copies/mL) was measured by means of real-time polymerase chain reaction at least once a month during a 12-month follow-up period.
  
  
  RESULTS
  BKV viremia was detected in 57 patients (19%), five (9%) in group 1 and 52 (22%) in group 2. Kaplan-Meier analyses showed that freedom from BKV viremia was significantly more frequent in group 1. The mean time of onset of BKV viremia was about four months after transplantation in both groups. The median viral load was greater in group 2 (12.5 ± 6.1 vs. 2.5 ± 1.8 × 10(4) copies/mL; p = 0.01). After the onset of BKV viremia, graft function significantly declined in group 2: 11 patients developed polyomavirus-associated nephropathy (PVAN) and four presumptive PVAN; nine experienced an acute rejection after the discontinuation of MPA, and 11 (21%) lost their graft. There was no graft loss in group 1.
  
  
  CONCLUSIONS
  These findings suggest that in comparison with MPA and Cya, an EVR and LD-CyA regimen lowers the risk of BKV viremia after kidney transplantation and favorably alters outcomes.
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy. moscarellil@libero.it
authors.forename: Luciano
authors.initials: L
authors.lastname: Moscarelli
authors.forename: Leonardo
authors.initials: L
authors.lastname: Caroti
authors.forename: Giulia
authors.initials: G
authors.lastname: Antognoli
authors.forename: Maria
authors.initials: M
authors.lastname: Zanazzi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Di Maria
authors.forename: Paolo
authors.initials: P
authors.lastname: Carta
authors.forename: Enrico
authors.initials: E
authors.lastname: Minetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001739:BK Virus / Q000187:drug effects; D016022:Case-Control Studies; D000068338:Everolimus; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D027601:Polyomavirus Infections / Q000188:drug therapy* / Q000821:virology; D011379:Prognosis; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy* / Q000821:virology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D009173:Mycophenolic Acid; D020123:Sirolimus
keywords: BK virus; everolimus; interstitial nephritis; kidney transplantation; mycophenolic acid; polyomavirus