Klinisch I - P05 - Treatment with tacrolimus versus cyclosporine A is a delicate ba­lan­ce between BK virus replication and rejection in renal trans­plant recipients

L. Gard, W. van Doesum, H.G.M Niesters, W.J. van Son, A. Diepstra, C.A. Stegeman, A. Riezebos-Brilman, J.S.F Sanders

Chair(s): dr. Jan Stephan F. Sanders, internist/nefroloog, UMC Groningen

Thursday 10 march 2016

12:30 - 13:00h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

Triple immunosuppressive therapy with prednisolone, mycophenolic acid and tacrolimus is associated with a low incidence of allograft rejection, but is associated with a higher incidence of BK nephropathy (BKVAN). We studied the frequency of BK virus (BKV) complications in renal transplant recipients treated with mycophenolate mofetil (MMF) or mycophenolic acid (MPS) and either cyclosporine A (CsA) or tacrolimus (Tac).

Retrospectively, 359 patients who received a renal transplant between 2010 and 2012, were treated with MPS or MMF in combination with CsA (CsA) or Tac (Tac) and mostly prednisolone, were studied . BKV DNA was measured in urine and EDTA-plasma samples. Protocolized renal biopsies were performed at 12 months and upon clinical indication. The incidence of BKVAN and course of BKV infection during 24 months follow-up was analysed. Other variables studied were estimated glomerular filtration rate (eGFR), occurrence of allograft rejection, loss of allograft and death.  

Incidence of BKV viremia was not significantly different between the CsA (n=42/190) (22.1%) and the Tac (n=36/169) (31.3%) group. However, biopsy proven BKVAN occurred more often in the Tac group (6.4%) versus the CsA group (2.1%) (p=0.04). 

Longitudinal data analysis showed a significant earlier decline of viral load in urine and EDTA-plasma in the CsA group (t=3 months) compared to the Tac group (t=6 months) (viremia p=0.005). 

Graft loss, eGFR and mortality rate did not differ in both treatment groups, as well as between the BKV positive vs. BKV negative group.  Incidence of rejection was significantly higher in the CsA (19.5%) compared to the Tac (11.2%) (p=0.03) group.

This study shows that  immunosuppressive treatment with Tac is associated with a lower incidence of rejection, but possibly at the cost of an increased risk of developing BKVAN in the first two years post-transplant. Overall transplant survival was similar, but for patients at high risk of developing BKVAN a cyclosporine based regimen could be considered.