Incidence of BK with Tacrolimus Versus Cyclosporine and Impact of Preemptive Immunosuppression Reduction
Article first published online: 21 JAN 2005
American Journal of Transplantation
Volume 5, Issue 3, pages 582–594, March 2005
How to Cite
Brennan, D. C., Agha, I., Bohl, D. L., Schnitzler, M. A., Hardinger, K. L., Lockwood, M., Torrence, S., Schuessler, R., Roby, T., Gaudreault-Keener, M. and Storch, G. A. (2005), Incidence of BK with Tacrolimus Versus Cyclosporine and Impact of Preemptive Immunosuppression Reduction. American Journal of Transplantation, 5: 582–594. doi: 10.1111/j.1600-6143.2005.00742.x
- Issue published online: 11 FEB 2005
- Article first published online: 21 JAN 2005
- Received 6 August 2004, revised 15 October 2004 and accepted for publication 18 October 2004
- kidney transplant;
Our purposes were to determine the incidence of BK viruria, viremia or nephropathy with tacrolimus (FK506) versus cyclosporine (CyA) and whether intensive monitoring and discontinuation of mycophenolate (MMF) or azathioprine (AZA), upon detection of BK viremia, could prevent BK nephropathy.
We randomized 200 adult renal transplant recipients to FK506 (n = 134) or CyA (n = 66). Urine and blood were collected weekly for 16 weeks and at months 5, 6, 9 and 12 and analyzed for BK by polymerase chain reaction (PCR).
By 1 year, 70 patients (35%) developed viruria and 23 (11.5%) viremia; neither were affected independently by FK506, CyA, MMF or AZA. Viruria was highest with FK506-MMF (46%) and lowest with CyA-MMF (13%), p = 0.005. Viruria ≥ 9.5 log10 copies/mL was associated with a 3-fold increased risk of viremia and a 13-fold increased risk of sustained viremia. After reduction of immunosuppression, viremia resolved in 95%, without increased acute rejection, allograft dysfunction or graft loss. No BK nephropathy was observed.
Choice of calcineurin inhibitor or adjuvant immunosuppression, independently, did not affect BK viruria or viremia. Viruria was highest with FK506-MMF and lowest with CyA-MMF. Monitoring and preemptive withdrawal of immunosuppression were associated with resolution of viremia and absence of BK nephropathy without acute rejection or graft loss.