Role of the Early Association of a mTOR Inhibitor and Tacrolimus in BK Polyomavirus Infection in Kidney Transplant Recipients

López, Verónica; Vazquez, Teresa; Jironda, Cristina; Cabello, Mercedes; Alonso, J. Blasco; León-Fradejas, M.; Hernández, Domingo

doi:10.1097/01.tp.0000543435.04901.45

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“…The impact of mTORi after BK viremia remains more conflicted. However, a recent retrospective study suggests that a conversion from a standard dose Tac‐MPA combination to a low‐dose Tac‐everolimus combination could be an efficient and safe strategy to rapidly control the infection, even in patients who develop BKVAN . Large‐scale, prospective, randomized studies comparing different strategies (including conversion to everolimus‐based regimens) are lacking.…”

Section: Discussionmentioning

confidence: 99%

No clinical benefit of rapid versus gradual tapering of immunosuppression to treat sustained BK virus viremia after kidney transplantation: a single‐center experience

et al. 2019

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Summary Immunosuppressive drug tapering is currently the recommended treatment of BK virus (BKV) viremia after kidney transplantation; however, its exact modalities remain unclear. We retrospectively compared two consecutive strategies in 111 patients with sustained viremia: a gradual monitoring/tapering group (GT, n = 57) before 2012 and a rapid monitoring/tapering group (RT, n = 54) after 2012. At viremia diagnosis, the dose of mycophenolic acid (MPA) and tacrolimus levels (T0) were similar among patient groups. However, following onset, the dose of MPA at 1 month (P = 0.002) and 3 months (P = 0.005) and Tac T0 at 1 month (P = 0.030) and 3 months (P = 0.006) were lower in the RT group. This rapid minimization shortened BKV viremia (P < 0.001) and resulted in a better protection of graft function in patients with confirmed BKV‐associated nephropathy (P = 0.033) without impacting 5‐year graft survival. Survival without rejection was similar (P = 0.571), but the RT group had increased the development of de novo donor‐specific antibodies (dnDSAs; P < 0.001). Multivariate Cox analysis identified basiliximab versus Thymoglobulin® induction [hazard ratio (HR), 3.090; P = 0.001] and the RT strategy (HR, 6.021; P = 0.002) as independently associated with dnDSAs. Compared to a gradual tapering, rapid immunosuppression tapering to treat sustained BKV viremia does not improve medium‐term clinical outcome but increases the risk of developing dnDSAs.

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Section: Discussionmentioning

confidence: 99%