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A delicate balance between rejection and BK polyomavirus associated nephropathy; A retrospective cohort study in

Lilli Gard1, Willem van Doesum2, Hubert G M Niesters1

  • 1Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

Plos One
|June 14, 2017
PubMed
Abstract

Insights

Tacrolimus (Tac) and mycophenolic acid (MPA) increase BK polyomavirus nephropathy (BKPyVAN) risk post-transplant compared to cyclosporine A (CsA) and MPA. While Tac reduces acute rejection, it elevates BKPyVAN incidence within two years.

Area of Science:

  • Nephrology
  • Immunosuppression
  • Virology

Background:

  • BK polyomavirus (BKPyV) complications, particularly BKPyVAN, are a concern in renal transplant recipients (RTR).
  • Immunosuppressive agents like mycophenolic acid (MPA) and tacrolimus (Tac) are linked to increased BKPyVAN incidence.

Purpose of the Study:

  • To compare the frequency of BKPyV complications over 24 months in RTR treated with MPA and either Tac (TacM group) or CsA (CsAM group).

Main Methods:

  • Observational retrospective cohort study of 358 RTR.
  • Patients received MPA with either CsA or Tac, along with prednisolone.
  • BKPyV complications, BKPyVAN, BKPyV-viremia, and biopsy-proven acute rejection (BPAR) were monitored.

Main Results:

  • BKPyV-viremia incidence was similar between groups (22.0% CsAM vs. 21.6% TacM).
  • Biopsy-proven BKPyVAN occurred significantly more often in the TacM group (6.6%) than the CsAM group (2.1%) (p=0.03).
  • The CsAM group showed earlier viral load decline (p=0.005), but higher BPAR rates (19.9% vs. 10.8%, p=0.02).

Conclusions:

  • Tacrolimus and MPA treatment is associated with a lower incidence of biopsy-proven acute rejection compared to CsA and MPA.
  • However, Tacrolimus and MPA treatment increases the risk of developing BKPyVAN within the first two years post-transplant.

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