title: Pilot conversion trial from mycophenolic acid to everolimus in ABO-incompatible kidney-transplant recipients with BK viruria and/or viremia.
abstract: Immunosuppression using everolimus (EVR) plus low-dose tacrolimus (Tac) is commonly used in organ transplantation. EVR has potential antiviral effects. Herein, the long-term outcomes and impacts of Tac-EVR on the BK virus are reported in ABO-incompatible kidney-transplant recipients. The initial immunosuppressive regimen combined steroids, Tac, and mycophenolic acid (MPA). At a median of 141 (34-529) days post-transplantation, seven stable ABO-incompatible kidney-transplant recipients were converted from MPA to EVR because of active BK replication, and compared with a reference group of fourteen ABO-incompatible patients receiving classical Tac plus MPA. At 1 month before conversion, at 1, 3 months after, and at last follow-up, clinical and biological parameters were monitored. The median time from conversion to the last follow-up was 784 (398-866) days. Conversion to EVR caused no change to rejection episodes or immunological status (isoagglutinin titers, anti-HLA antibodies). At last follow-up, median eGFR was similar in the Tac-MPA versus Tac-EVR group (40 [range: 14-56] vs. 54.5 ml/min/1.73 m(2) [range: 0-128], P = 0.07). The major adverse event was dyslipidemia. Interestingly, conversion from MPA to EVR decreased BK viral load in five patients. ABO-incompatible kidney-transplant recipients with an active BK virus infection may benefit from conversion to EVR.
authors.affiliation: Department of Nephrology and Organ Transplantation, University Hospital, Toulouse, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Belliere
authors.affiliation: Department of Nephrology and Organ Transplantation, University Hospital, Toulouse, France.|INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France.|University Paul Sabatier, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.affiliation: INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France.|Department of Virology, CHU Purpan, Toulouse, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mengelle
authors.affiliation: Department of Nephrology and Organ Transplantation, University Hospital, Toulouse, France.
authors.forename: Asma
authors.initials: A
authors.lastname: Allal
authors.affiliation: Department of Urology and Kidney Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Federico
authors.initials: F
authors.lastname: Sallusto
authors.affiliation: Department of Urology and Kidney Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doumerc
authors.affiliation: Department of Urology and Kidney Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Game
authors.affiliation: University Paul Sabatier, Toulouse, France.|Laboratory of Immunology, CHU Rangueil, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Congy-Jolivet
authors.affiliation: Department of Nephrology and Organ Transplantation, University Hospital, Toulouse, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Esposito
authors.affiliation: Etablissement Français du Sang, CHU Purpan, Toulouse, France.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Debiol
authors.affiliation: Department of Nephrology and Organ Transplantation, University Hospital, Toulouse, France.|INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France.|University Paul Sabatier, Toulouse, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D000368:Aged; D001739:BK Virus; D000068338:Everolimus / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage; D010865:Pilot Projects; D027601:Polyomavirus Infections; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage; D014412:Tumor Virus Infections; D014766:Viremia; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D000068338:Everolimus; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: ABO-incompatible transplant recipient; BK virus; everolimus; kidney transplantation; mycophenolic acid