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Type: Journal article
Title: Polyomavirus BK replication in de novo kidney transplant patients receiving tacrolimus or cyclosporine: A prospective, randomized, multicenter study
Author: Hirsch, H.
Vincenti, F.
Friman, S.
Tuncer, M.
Citterio, F.
Wiecek, A.
Scheuermann, E.
Klinger, M.
Russ, G.
Pescovitz, M.
Prestele, H.
Citation: American Journal of Transplantation, 2013; 13(1):136-145
Publisher: Blackwell Munksgaard
Issue Date: 2013
ISSN: 1600-6135
Statement of
H. H. Hirsch, F. Vincenti, S. Friman, M. Tuncer, F. Citterio, A. Wiecek, E. H. Scheuermann, M. Klinger, G. Russ, M. D. Pescovitz and H. Prestele
Abstract: Polyomavirus BK (BKV)-associated nephropathy causes premature kidney transplant (KT) failure. BKV viruria and viremia are biomarkers of disease progression, but associated risk factors are controversial. A total of 682 KT patients receiving basiliximab, mycophenolic acid (MPA), corticosteroids were randomized 1:1 to cyclosporine (CsA) or tacrolimus (Tac). Risk factors were analyzed in 629 (92.2%) patients having at least 2 BKV measurements until month 12 posttransplant. Univariate analysis associated CsA-MPA with lower rates of viremia than Tac-MPA at month 6 (10.6% vs. 16.3%, p = 0.048) and 12 (4.8% vs. 12.1%, p = 0.004) and lower plasma BKV loads at month 12 (3.9 vs. 5.1 log10 copies/mL; p = 0.028). In multivariate models, CsA-MPA remained associated with less viremia than Tac-MPA at month 6 (OR 0.60; 95% CI 0.36–0.99) and month 12 (OR 0.33; 95% CI 0.16–0.68). Viremia at month 6 was also independently associated with higher steroid exposure until month 3 (OR 1.19 per 1 g), and with male gender (OR 2.49) and recipient age (OR 1.14 per 10 years) at month 12. The data suggest a dynamic risk factor evolution of BKV viremia consisting of higher corticosteroids until month 3, Tac-MPA compared to CsA-MPA at month 6 and Tac-MPA, older age, male gender at month 12 posttransplant.
Keywords: BK virus; cyclosporine; immunosuppression; polyomavirus; risk factor; steroids; tacrolimus; transplantation
Rights: © Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons
RMID: 0020137250
DOI: 10.1111/j.1600-6143.2012.04320.x
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