Author(s): Hardinger KL, Koch MJ, Bohl DJ, Storch GA, Brennan DC
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Abstract A 1-year, single-center, randomized trial demonstrated that the calcineurin inhibitor or adjuvant immunosuppression, independently, does not affect BK-viruria or viremia and that monitoring and pre-emptive withdrawal of immunosuppression was associated with resolution of BK-viremia and absence of clinical BK-nephropathy without acute rejection or graft loss. A retrospective 5-year review of this trial was conducted. In cases of BK viremia, the antimetabolite was withdrawn and for sustained viremia, the calcineurin inhibitor was minimized. Five-year follow-up was available on 97\% of patients. Overall 5-year patient survival was 91\% and graft survival was 84\%. There were no differences in patient-survival by immunosuppressive regimen or presence of BK-viremia. Immunosuppression and viremia did not influence graft survival. Acute rejection occurred in 12\% by 5-years after transplant, was less common with tacrolimus versus cyclosporine (9\% vs. 18\%; p = 0.082), and was lowest with the tacrolimus-azathioprine regimen (5\%, p = 0.127). Tacrolimus was associated with better renal function at 5-years (eGFR 63 FK vs. 52 CsA mL/min, p = 0.001). Minimization of immunosuppression upon detection of BK-viremia was associated with excellent graft survival at 5-years, low rejection rates and excellent renal function. It is a safe, short and long-term strategy that resulted in freedom from clinically evident BK-virus nephropathy.
This article was published in Am J Transplant
and referenced in Journal of Addiction Research & Therapy