Authors' Reply to Maintenance Immunosuppressive Agents as Risk Factors for BK Virus Nephropathy

Mammalian target of rapamycin signal inhibitors could play a role in the treatment of BK polyomavirus nephritis in renal allograft recipients

“…It is generally accepted that the degree of immunosuppression is the primary risk factor for development of BKVN (5, 18). Several clinical studies have shown an association between BKVN and Tac (19–23), although some did not observe greater incidence when this drug was compared with cyclosporine (8). The clinical relationship between mycophenolate and BKVN is controversial, and some authors did not find a correlation (21–24), whereas others showed a greater incidence when mycophenolate was used (25), particularly when combined with Tac (20, 23).…”

“…Several clinical studies have shown an association between BKVN and Tac (19–23), although some did not observe greater incidence when this drug was compared with cyclosporine (8). The clinical relationship between mycophenolate and BKVN is controversial, and some authors did not find a correlation (21–24), whereas others showed a greater incidence when mycophenolate was used (25), particularly when combined with Tac (20, 23). The association between corticosteroids and BKVN is also controversial, although some reports indicate that corticosteroid therapy could be a risk factor for BKVN (21, 26).…”

“…The clinical relationship between mycophenolate and BKVN is controversial, and some authors did not find a correlation (21–24), whereas others showed a greater incidence when mycophenolate was used (25), particularly when combined with Tac (20, 23). The association between corticosteroids and BKVN is also controversial, although some reports indicate that corticosteroid therapy could be a risk factor for BKVN (21, 26). Use of rabbit ATG in induction is also associated with a higher risk of BKVN (23).…”