628. Incidence and Outcome of BK Viruria/Viremia in Renal Transplant Recipients Receiving Duo-therapy; A Randomized Controlled Multicenter Study
Session: Oral Abstract Session: Infections in Transplantations and Immunocompromised
Friday, October 4, 2013: 9:00 AM
Room: The Moscone Center: 220-226
Background:

BK virus is ubiquitous and widely spread in adult human populations. Infection results in lifelong persistence of the virus. BK may cause nephropathy in renal transplant recipients. It remains unclear whether the overall degree of immunosuppression or the combination of immunosuppresiva is mainly responsible for the increased risk of BK detection in renal transplant recipients.  

Methods:

A randomized controlled, prospective multicentre trial in 362 de novorenal transplant recipients was performed. 91 patients were excluded during the course of the study. At 6 months patients were randomised into three treatment groups with dual therapy consisting of prednisolon with either cyclosporine, mycophenolate sodium or everolimus. Urine and serum samples were collected and at time point 6 and 24 months a renal biopsy was performed. BKV DNA was measured in all samples and pre-transplant BK-specific serology was performed. Primary outcome was incidence of BK viruria, BK viremia and BK nephopathy during 2 years of follow up.

Results:

Pre-transplant seroprevalence was 48,2%. In total, 84 of the 271 renal transplant recipients (31.0%) had at least one positive test for BK DNA. Viruria could be detected in 29.5% (10,3% transient vs. 19,2% sustained), viremia was found in 15.5% of the patients (12,9% transient vs. 2,6% sustained). BK nephropathy was diagnosed in 3 patients (1.1%). Incidence of BK viremia/viruria in de the mycophenolate sodium group was significantly higher than in the other groups (p=0.04) but there were no significant differences in severity of BK induced disease between the groups (p=0.67). A positive trend between primo BK infections and increased incidence of viremia was observed (p=0.07).

Conclusion:

In this cohort with relative low BK seroprevalence, dual mild immunosuppressive regimes were associated with a lower incidence of BK nephropathy compared to the literature. Furthermore, the use of prednisolone and MPS was correlated with a higher incidence of BK viremia/viruria, but did not have an effect on the severity of the disease. Finally, primo infections seem to be correlated with an increased incidence of BK viremia.

 

Willem Van Doesum1, Lilli Gard, BSc2, Frederike Bemelman, MD, PhD3, Johan De Fijter, MD, PhD4, Bert Niesters, PhD2, Willem Van Son, MD, PhD1, Annelies Riezebos-Brilman, MD, PhD2 and Jan-Stephan Sanders, MD, PhD1, (1)Nephrology, University Medical Center Groningen, Groningen, Netherlands, (2)Medical Microbiology, University Medical Center Groningen, Groningen, Netherlands, (3)Renal Tranplant Unit, Academic Medical Centre, Amsterdam, Netherlands, (4)Renal Transplant Unit, Leiden University Medical Centre, Leiden, Netherlands

Disclosures:

W. Van Doesum, None

L. Gard, None

F. Bemelman, None

J. De Fijter, None

B. Niesters, None

W. Van Son, None

A. Riezebos-Brilman, None

J. S. Sanders, None

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