Methods: Retrospectively consecutive 364 patients who received a renal transplant between 2010 and 2012 and treated with MPS/CsA or MPS/T and mostly prednisolone, were studied during a follow up of 24 months. BKV DNA was measured in urine and plasma samples. Renal biopsies were performed at 12 months and upon clinical indication. The incidence of BKVAN and course of BKV infection during this period was analysed. Other variables studied were estimated glomerular filtration rate (eGFR), occurrence of allograft rejection, loss of allograft and death.
Results: Incidence of BKV viremia was not significantly different between the MPS/CsA (n=38/193) (19.7%) and the MPS/T (n=27/171) (15.8%) group. However, biopsy proven BKVAN occurred more often in the MPS/T group (6.4%) versus the MPS/CsA group (2.1%) (p=0.04). Longitudinal data analysis showed a significant earlier decline of viral load in urine and plasma in the MPS/CsA group (t=3 months) compared to the MPS/T group (t=6 months) (viruria p=0.006, viremia p=0.007). Graft loss, eGFR and mortality rate were comparable in both treatment groups and BKV positive vs. BKV negative group. Whereas the occurrence of rejection in the two treatment groups and also in BKV positive recipients within these groups, was higher in the MPS/CsA (19.7%/28%) compared to the MPS/T (11.7%) (p=0.04) and (7.3%) (p=0.005) respectively.
Conclusion: Immunosuppressive treatment with MPS/T was associated with an increased risk of BKVAN, however, incidence of allograft rejection was lower compared to MPS/CsA. For patients at high risk of developing BKVAN a cyclosporine based regimen could be considered.
B. Niesters, None
W. Van Son, None
C. A. Stegeman, None
A. Riezebos-Brilman, None
J. S. Sanders, None
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