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Management and outcome of BK viremia in renal transplant recipients: a prospective single-center study. Transplantation 2012 Oct 27;94(8):814-21

Date

09/29/2012

Pubmed ID

23018881

DOI

10.1097/TP.0b013e31826690c6

Scopus ID

2-s2.0-84868207563   51 Citations

Abstract

BACKGROUND: BK viremia can lead to nephritis, which can progress to irreversible kidney transplant failure. Our prospective study provides management and outcome of BK viremia in renal transplant recipients.

METHODS: Two hundred forty de novo kidney-only recipients were enrolled from July 2007 to July 2010 and followed for 1 year. Standard immunosuppression with Thymoglobulin/interleukin 2 receptor blocker and mycophenolate mofetil/tacrolimus (Tac)/prednisone was employed. Quantitative BK virus (BKV) DNA surveillance in plasma/urine was performed at 1, 3, 6, 12, and 24 months after transplantation. Patients with significant viremia (defined as ≥10,000 viral copies/mL) underwent renal biopsy and treated with 30% to 50% reduction in doses of both mycophenolate mofetil and Tac without antiviral therapy. The target 12-hr Tac trough levels were lowered to 4 to 6 ng/mL in the significant viremia group, whereas the target levels remained unchanged at 5 to 8 ng/mL for all other groups.

RESULTS: Sixty-five patients (27%) developed BK viremia; 28 (12%) of whom had significant viremia. A total of five (21%) of the 23 (of 28) patients who underwent biopsy presented with subclinical BKV nephritis. The mean plasma BKV DNA declined by 98% (range, 76%-100%) at 1 year after peak viremia. Acute cellular rejection seen in four (14%) of 28 patients, responded to bolus steroids. There was no decline in estimated glomerular filtration rate over time from 1 month after transplantation to 1 year after peak viremia (P=0.57).

CONCLUSION: Reduction in immunosuppression alone resulted in the successful resolution of viremia with preservation of renal function and prevention of clinical BKV nephritis and graft loss.

Author List

Sood P, Senanayake S, Sujeet K, Medipalli R, Zhu YR, Johnson CP, Hariharan S

Author

Christopher P. Johnson MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
BK Virus
Biopsy
Female
Humans
Kidney
Kidney Transplantation
Male
Middle Aged
Mycophenolic Acid
Nephritis
Polyomavirus Infections
Postoperative Complications
Prospective Studies
Tacrolimus
Treatment Outcome
Tumor Virus Infections
Viral Load
Viremia
jenkins-FCD Prod-478 d1509cf07a111124a2d122fd3df854cc0b993c00