title: Influence of tacrolimus metabolism rate on BKV infection after kidney transplantation.
abstract: Immunosuppression is the major risk factor for BK virus nephropathy (BKVN) after renal transplantation (RTx). As the individual tacrolimus (Tac) metabolism rate correlates with Tac side effects, we hypothesized that Tac metabolism might also influence the BKV infection risk. In this case-control study RTx patients with BK viremia within 4 years after RTx (BKV group) were compared with a BKV negative control group. The Tac metabolism rate expressed as the blood concentration normalized by the daily dose (C/D ratio) was applied to assess the Tac metabolism rate. BK viremia was detected in 86 patients after a median time of 6 (0-36) months after RTx. BKV positive patients showed lower Tac C/D ratios at 1, 3 and 6 months after RTx and were classified as fast Tac metabolizers. 8 of 86 patients with BK viremia had histologically proven BKN and a higher median maximum viral load than BKV patients without BKN (441,000 vs. 18,572 copies/mL). We conclude from our data that fast Tac metabolism (C/D ratio <1.05) is associated with BK viremia after RTx. Calculation of the Tac C/D ratio early after RTx, may assist transplant clinicians to identify patients at risk and to choose the optimal immunosuppressive regimen.
authors: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors: Gerold
authors: G
authors: Thölking
authors: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors: Christina
authors: C
authors: Schmidt
authors: Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
authors: Raphael
authors: R
authors: Koch
authors: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors: Katharina
authors: K
authors: Schuette-Nuetgen
authors: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors: Dirk
authors: D
authors: Pabst
authors: Department of General Surgery, University Hospital of Münster, Münster, Germany.
authors: Heiner
authors: H
authors: Wolters
authors: Department of Transplant Medicine, University Hospital of Münster, Münster, Germany.
authors: Iyad
authors: I
authors: Kabar
authors: Department of Transplant Medicine, University Hospital of Münster, Münster, Germany.
authors: Anna
authors: A
authors: Hüsing
authors: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors: Hermann
authors: H
authors: Pavenstädt
authors: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors: Stefan
authors: S
authors: Reuter
authors: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors: Barbara
authors: B
authors: Suwelack
mesh_terms: D000328:Adult; D000368:Aged; D001739:BK Virus / Q000187:drug effects* / Q000502:physiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000378:metabolism / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000188:drug therapy* / Q000821:virology; D012307:Risk Factors; D016559:Tacrolimus / Q000378:metabolism / Q000627:therapeutic use*; D013997:Time Factors; D014412:Tumor Virus Infections / Q000188:drug therapy* / Q000821:virology; D014766:Viremia / Q000175:diagnosis / Q000821:virology
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus