BK polyomavirus and valganciclovir: Highly suspected association urgently calling for a new randomized trial

Reischig, Tomáš; Kacer, Martin; Hes, Ondřej; Máchová, Jana; Němcová, Jana; Lysák, Daniel; Jindra, Pavel; Pivovarčíková, Kristýna; Kormunda, Stanislav; Bouda, Mirko

doi:10.1111/ajt.15598

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…We did not notice an association between CMV and the occurrence of BK viremia. Interestingly, there is data suggesting that BK viremia is related to valganciclovir prophylaxis [29]. However, we could not observe this association [30].…”

Section: Discussioncontrasting

confidence: 74%

Cytomegalovirus Viremia after Living and Deceased Donation in Kidney Transplantation

Jehn

Schütte‐Nütgen

Bautz

et al. 2020

JCM

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Despite screening, effective anti-viral drugs and risk-balanced prophylaxis, cytomegalovirus (CMV) remains a major cause of morbidity in transplant patients. The objective of this study was to retrospectively analyze the risk factors associated with CMV viremia after kidney transplantation in a large European cohort with standardized valganciclovir prophylaxis in the present era. A special focus was placed on the comparison of living and postmortal donation. We conducted a longitudinal observational study involving 723 adult patients with a total of 3292 patient-years who were transplanted at our center between 2007 and 2015. Valganciclovir prophylaxis was administered over 100 days for CMV+ donors (D) or recipients (R), over 200 days for D+/R−, and none in D−/R−. A CMV+ donor, rejection episodes, and deceased donor transplantation were identified to be associated with increased incidences of CMV viremia. Although we did not find a reduced overall survival rate for patients with CMV viremia, it was associated with worse graft function. Since we observed a relevant number of CMV infections despite prescribing valganciclovir prophylaxis, a pre-emptive strategy in patients with (suspected) adherence restrictions could be favored. Our data can help transplant physicians educate their patients about their individual CMV risk and choose the most appropriate CMV treatment approach.

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Section: Discussioncontrasting

confidence: 74%

Cytomegalovirus Viremia after Living and Deceased Donation in Kidney Transplantation

Jehn

Schütte‐Nütgen

Bautz

et al. 2020

JCM

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“…A recent post-hoc analysis on 2 RCTs evaluating different CMV prevention regimens [ 24,35 ] showed that the incidence of both BK viremia and PVAN was increased in patients treated with VGC prophylaxis compared to those receiving VAC prophylaxis or preemptive therapy [ 40 ]. Given that the authors also found less rejection and late graft fibrosis with VGC prophylaxis compared to VAC [ 35,41 ] and further supported by several in-vitro studies [ [42][43][44][45], the authors speculate that VGC may have immunosuppressive properties.…”

Section: Insert Tablementioning

confidence: 92%

Cytomegalovirus after kidney transplantation in 2020: moving towards personalized prevention

Hellemans

Abramowicz

2020

Nephrology Dialysis Transplantation

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Cytomegalovirus (CMV)-related complications after kidney transplantation remain a substantial challenge. Rather than applying one preventive strategy to all at-risk patients, we can now adapt our strategy at the individual patient level. Antiviral prophylaxis or a strict pre-emptive strategy may be optimal for patients at the highest risk for CMV, while patients at lower risk may benefit particularly from pre-emptive monitoring and the administration of therapy only if needed. CMV-specific T-cell assays may be useful for further refining the pre-transplant determination of CMV risk, and for guiding decisions about antiviral therapy need or duration. An immunosuppressive regimen including a mammalian target of rapamycin inhibitor reduces CMV risk and may thus be an attractive option in some patients. New antiviral agents may further expand our therapeutic arsenal in the near future, and the prospects of CMV vaccination and adoptive T-cell therapy appear to be on the horizon.

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Is Polyomavirus-Associated Nephropathy More Common in Kidney Transplant Recipients Exposed to Valganciclovir? A Retrospective Single Center Analysis

Hellemans

Bertels

Wijtvliet

et al. 2023

Transplantation Proceedings

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BK polyomavirus and valganciclovir: Highly suspected association urgently calling for a new randomized trial

Cited by 3 publications

References 5 publications

Cytomegalovirus Viremia after Living and Deceased Donation in Kidney Transplantation

Cytomegalovirus Viremia after Living and Deceased Donation in Kidney Transplantation

Cytomegalovirus after kidney transplantation in 2020: moving towards personalized prevention

Is Polyomavirus-Associated Nephropathy More Common in Kidney Transplant Recipients Exposed to Valganciclovir? A Retrospective Single Center Analysis

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