1207. The Delicate Balance Between Rejection and BK Virus Replication in Renal Transplant Recipients Treated with Tacrolimus versus Cyclosporine
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
  • Poster IDweek number 1207.pdf (76.2 kB)
  • Background: Triple immunosuppressive therapy with prednisolone, mycophenolic acid and tacrolimus is associated with a low incidence of allograft rejection, but is associated with a higher incidence of BK nephropathy (BKVAN). We studied the frequency of BK virus complications in renal transplant recipients treated with mycophenolic acid (MPS) and either cyclosporine A (CsA) or tacrolimus (T).

    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.

    Lilli Gard, BSc1, Willem Van Doesum, bc2, Bert Niesters, PhD1, Willem Van Son, MD, PhD2, Coen a. Stegeman, MD, PhD2, Annelies Riezebos-Brilman, MD, PhD1 and Jan-Stephan Sanders, MD, PhD2, (1)Medical Microbiology, University Medical Center Groningen, Groningen, Netherlands, (2)Nephrology, University Medical Center Groningen, Groningen, Netherlands


    L. Gard, None

    W. Van Doesum, None

    B. Niesters, None

    W. Van Son, None

    C. A. Stegeman, None

    A. Riezebos-Brilman, None

    J. S. Sanders, None

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