BK-Virus and the Impact of Pre-Emptive Immunosuppression Reduction: 5-Year Results

被引:157
作者
Hardinger, K. L. [3 ]
Koch, M. J. [1 ]
Bohl, D. J. [1 ]
Storch, G. A. [2 ,4 ]
Brennan, D. C. [1 ]
机构
[1] Washington Univ, Sch Med, Dept Internal Med, St Louis, MO 63110 USA
[2] Washington Univ, Sch Med, Dept Pediat, St Louis, MO 63110 USA
[3] Univ Missouri, Dept Pharm Practice, Kansas City, MO 64110 USA
[4] St Louis Childrens Hosp, Virol Lab, St Louis, MO 63178 USA
关键词
Immunosuppressant therapy; kidney transplantation; Polyoma BK virus; pre-emptive antiviral therapy; RENAL-TRANSPLANT RECIPIENTS; VIREMIC PATIENTS; POLYOMAVIRUS BK; NEPHROPATHY; NEPHRITIS; DIAGNOSIS; KIDNEY; URINE;
D O I
10.1111/j.1600-6143.2009.02952.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
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 In cases of BK viremia, the antimetabolite was withdrawn and for sustained viremia, the calcineurin inhibitor was minimized.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.
引用
收藏
页码:407 / 415
页数:9
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