BK Nephropathy in Kidney Transplant Recipients Treated with a Calcineurin Inhibitor-Free Immunosuppression Regimen

Department of Surgery, University of California-San Francisco, San Francisco, California, USA.
American Journal of Transplantation (Impact Factor: 5.68). 01/2005; 4(12):2132-4. DOI: 10.1046/j.1600-6143.2004.00600.x
Source: PubMed


Recently, polyomavirus-associated nephropathy (PVAN) has been reported more frequently and is emerging as an important cause of renal allograft dysfunction and graft loss. Susceptibility appears to be related to the type and intensity of pharmacologic immunosuppression but some reports have suggested a link among the development of PVAN, the treatment of rejection or maintenance with a tacrolimus-based immunosuppressive regimen. We report three cases of PVAN in patients who never received immunosuppression with calcineurin inhibitors (CNIs). Two patients received induction immunosuppression consisting of an IL-2 receptor antagonist while 1 received thymoglobulin. These 3 patients were maintained on prednisone, sirolimus and mycophenolate mofetil (MMF) and none was treated for rejection. All three patients presented with an elevated serum creatinine and demonstrated polyomavirus infection on biopsy and by blood PCR. These cases demonstrate that, unlike reports linking tacrolimus and PVAN, polyomavirus infection may develop in patients maintained on CNI-free immunosuppressive regimens and have not had episodes of rejection.

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Available from: Stuart M Flechner, Nov 10, 2014
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    • "A randomized, single-center trial comparing CsA vs tacrolimus used BKN as a primary end point; but because no cases of BKN occurred before the last study visit in either trial, the risk associated with choice of CNI could not be assessed [9]. However, because the presence of BK viruria and/or viremia shows a close association with BKN and subsequent graft loss [36] [37], the relationship between CNIs and urine or plasma positivity is also important. In the prospective DIRECT study [38] [39] [40], in which de novo kidney transplant recipients were randomized to CsA or tacrolimus, both with MPA and corticosteroids, BK viremia was a predefined secondary end point. "
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