Document Detail


Management and outcome of BK viremia in renal transplant recipients: a prospective single-center study.
MedLine Citation:
PMID:  23018881     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Puneet Sood; Shamila Senanayake; Kumar Sujeet; Radhika Medipalli; Yong R Zhu; Christopher P Johnson; Sundaram Hariharan
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation     Volume:  94     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-22     Completed Date:  2012-12-27     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  814-21     Citation Subset:  IM    
Affiliation:
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
BK Virus / isolation & purification*
Biopsy
Female
Humans
Kidney / pathology
Kidney Transplantation / adverse effects*
Male
Middle Aged
Mycophenolic Acid / administration & dosage,  analogs & derivatives
Nephritis / prevention & control
Polyomavirus Infections / drug therapy*
Postoperative Complications / drug therapy*
Prospective Studies
Tacrolimus / administration & dosage
Treatment Outcome
Tumor Virus Infections / drug therapy*
Viral Load
Viremia / diagnosis,  drug therapy*,  virology
Chemical
Reg. No./Substance:
109581-93-3/Tacrolimus; 24280-93-1/Mycophenolic Acid; 9242ECW6R0/mycophenolate mofetil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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