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Polyomavirus BK Replication in De Novo Kidney Transplant Patients Receiving Tacrolimus or Cyclosporine: A Prospective, Randomized, Multicenter Study

  1. H. H. Hirsch1,2,†,*,
  2. F. Vincenti3,
  3. S. Friman4,
  4. M. Tuncer5,
  5. F. Citterio6,
  6. A. Wiecek7,
  7. E. H. Scheuermann8,
  8. M. Klinger9,
  9. G. Russ10,
  10. M. D. Pescovitz11,
  11. H. Prestele12

Article first published online: 8 NOV 2012

DOI: 10.1111/j.1600-6143.2012.04320.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 13, Issue 1, pages 136–145, January 2013

Additional Information

How to Cite

Hirsch, H. H., Vincenti, F., Friman, S., Tuncer, M., Citterio, F., Wiecek, A., Scheuermann, E. H., Klinger, M., Russ, G., Pescovitz, M. D. and Prestele, H. (2013), Polyomavirus BK Replication in De Novo Kidney Transplant Patients Receiving Tacrolimus or Cyclosporine: A Prospective, Randomized, Multicenter Study. American Journal of Transplantation, 13: 136–145. doi: 10.1111/j.1600-6143.2012.04320.x

Author Information

  1. 1

    Transplantation and Clinical Virology, Department Biomedicine—Building Petersplatz, University of Basel, Basel, Switzerland

  2. 2

    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland

  3. 3

    University of California San Francisco, Kidney Transplant Service, San Francisco, CA

  4. 4

    Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

  5. 5

    MedicalPark Hospital, Organ Transplant Center, Antalya, Turkey

  6. 6

    Division of Organ Transplantation, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy

  7. 7

    Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland

  8. 8

    Department of Nephrology, University Hospital, Frankfurt am Main, Germany

  9. 9

    Department of Nephrology and Transplantation Medicine, Medical University, Wroclaw, Poland

  10. 10

    The Queen Elizabeth Hospital, Woodwille, Australia

  11. 11

    Departments of Surgery and Microbiology/Immunology, Indiana University, Indianapolis, IN

  12. 12

    Novartis Pharma AG, Basel, Switzerland

  1. †

    On behalf of the Diabetes Incidence after Renal Transplantation: Neoral® C2 monitoring versus Tacrolimus (DIRECT) investigators (see Acknowledgments)

*Corresponding author: Hans H. Hirsch, hans.hirsch@unibas.ch

  1. †

    On behalf of the Diabetes Incidence after Renal Transplantation: Neoral® C2 monitoring versus Tacrolimus (DIRECT) investigators (see Acknowledgments)

Publication History

  1. Issue published online: 26 DEC 2012
  2. Article first published online: 8 NOV 2012
  3. Manuscript Revised: 6 SEP 2012
  4. Manuscript Received: 21 MAY 2012

Funded by

  • Novartis Pharma

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Keywords:

  • BK virus;
  • cyclosporine;
  • immunosuppression;
  • polyomavirus;
  • risk factor;
  • steroids;
  • tacrolimus;
  • transplantation

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.

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