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BK-virus and the impact of pre-emptive immunosuppression reduction: 5-year results Hardinger KL; Koch MJ; Bohl DJ; Storch GA; Brennan DCAm J Transplant 2010[Feb]; 10 (2): 407-15A 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 In cases of BK viremia, the antimetabolite was withdrawn and for sustained viremia, the calcineurin inhibitor was minimized.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.|Azathioprine/therapeutic use[MESH]|BK Virus/*drug effects[MESH]|Cyclosporine/therapeutic use[MESH]|Graft Survival/drug effects[MESH]|Humans[MESH]|Immunosuppression Therapy/*methods[MESH]|Immunosuppressive Agents/*therapeutic use[MESH]|Kidney Diseases[MESH]|Kidney Function Tests[MESH]|Tacrolimus/therapeutic use[MESH]|Viremia[MESH] |
