TY - JOUR
T1 - Incidence of BK with tacrolimus versus cyclosporine and impact of preemptive immunosuppression reduction
AU - Brennan, Daniel C.
AU - Agha, Irfan
AU - Bohl, Daniel L.
AU - Schnitzler, Mark A.
AU - Hardinger, Karen L.
AU - Lockwood, Mark
AU - Torrence, Stephanie
AU - Schuessler, Rebecca
AU - Roby, Tiffany
AU - Gaudreault-Keener, Monique
AU - Storch, Gregory A.
PY - 2005/3
Y1 - 2005/3
N2 - Our purposes were to determine the incidence of BK viruria, viremia or nephropathy with tacrolimus (FK506) versus cyclosporine (CyA) and whether intensive monitoring and discontinuation of mycophenolate (MMF) or azathioprine (AZA), upon detection of BK viremia, could prevent BK nephropathy. We randomized 200 adult renal transplant recipients to FK506 (n = 134) or CyA (n = 66). Urine and blood were collected weekly for 16 weeks and at months 5, 6, 9 and 12 and analyzed for BK by polymerase chain reaction (PCR). By 1 year, 70 patients (35%) developed viruria and 23 (11.5%) viremia; neither were affected independently by FK506, CyA, MMF or AZA. Viruria was highest with FK506-MMF (46%) and lowest with CyA-MMF (13%), p = 0.005. Viruria ≥ 9.5 log10 copies/mL was associated with a 3-fold increased risk of viremia and a 13-fold increased risk of sustained viremia. After reduction of immunosuppression, viremia resolved in 95%, without increased acute rejection, allograft dysfunction or graft loss. No BK nephropathy was observed. Choice of calcineurin inhibitor or adjuvant immunosuppression, independently, did not affect BK viruria or viremia. Viruria was highest with FK506-MMF and lowest with CyA-MMF. Monitoring and preemptive withdrawal of immunosuppression were associated with resolution of viremia and absence of BK nephropathy without acute rejection or graft toss.
AB - Our purposes were to determine the incidence of BK viruria, viremia or nephropathy with tacrolimus (FK506) versus cyclosporine (CyA) and whether intensive monitoring and discontinuation of mycophenolate (MMF) or azathioprine (AZA), upon detection of BK viremia, could prevent BK nephropathy. We randomized 200 adult renal transplant recipients to FK506 (n = 134) or CyA (n = 66). Urine and blood were collected weekly for 16 weeks and at months 5, 6, 9 and 12 and analyzed for BK by polymerase chain reaction (PCR). By 1 year, 70 patients (35%) developed viruria and 23 (11.5%) viremia; neither were affected independently by FK506, CyA, MMF or AZA. Viruria was highest with FK506-MMF (46%) and lowest with CyA-MMF (13%), p = 0.005. Viruria ≥ 9.5 log10 copies/mL was associated with a 3-fold increased risk of viremia and a 13-fold increased risk of sustained viremia. After reduction of immunosuppression, viremia resolved in 95%, without increased acute rejection, allograft dysfunction or graft loss. No BK nephropathy was observed. Choice of calcineurin inhibitor or adjuvant immunosuppression, independently, did not affect BK viruria or viremia. Viruria was highest with FK506-MMF and lowest with CyA-MMF. Monitoring and preemptive withdrawal of immunosuppression were associated with resolution of viremia and absence of BK nephropathy without acute rejection or graft toss.
KW - BK
KW - Immunosuppression
KW - Kidney transplant
KW - Polyomavirus
KW - Preemptive
UR - http://www.scopus.com/inward/record.url?scp=20044363947&partnerID=8YFLogxK
U2 - 10.1111/j.1600-6143.2005.00742.x
DO - 10.1111/j.1600-6143.2005.00742.x
M3 - Article
C2 - 15707414
AN - SCOPUS:20044363947
SN - 1600-6135
VL - 5
SP - 582
EP - 594
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 3
ER -