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Everolimus leads to a lower risk of BKV viremia than mycophenolic acid in de novo renal transplantation patients: a single‐center experience
Author(s) -
Moscarelli Luciano,
Caroti Leonardo,
Antognoli Giulia,
Zanazzi Maria,
Di Maria Lorenzo,
Carta Paolo,
Minetti Enrico
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12151
Subject(s) - medicine , single center , mycophenolic acid , everolimus , viremia , transplantation , renal transplant , kidney transplantation , immunology , human immunodeficiency virus (hiv)
Background There are limited published data concerning the effects of different immunosuppressive regimens on the development of polyomavirus ( BKV ) viremia. We examined the risk of developing BKV viremia in kidney transplant recipients receiving everolimus ( EVR ) or mycophenolic acid ( MPA ) as maintenance therapy. Methods We observationally analyzed 296 patients who underwent renal transplantation at our center between 2005 and 2010: 58 were treated with EVR and low‐dose cyclosporine (LD‐CyA) (group 1) and 238 with MPA and standard‐dose CyA (group 2). All of the patients received induction therapy with basiliximab and maintenance steroids. BKV viremia (a whole‐blood viral load of >850 copies/ mL ) was measured by means of real‐time polymerase chain reaction at least once a month during a 12‐month follow‐up period. Results BKV viremia was detected in 57 patients (19%), five (9%) in group 1 and 52 (22%) in group 2. Kaplan–Meier analyses showed that freedom from BKV viremia was significantly more frequent in group 1. The mean time of onset of BKV viremia was about four months after transplantation in both groups. The median viral load was greater in group 2 (12.5 ± 6.1 vs. 2.5 ± 1.8 × 10 4 copies/ mL ; p = 0.01). After the onset of BKV viremia, graft function significantly declined in group 2: 11 patients developed polyomavirus‐associated nephropathy (PVAN) and four presumptive PVAN; nine experienced an acute rejection after the discontinuation of MPA, and 11 (21%) lost their graft. There was no graft loss in group 1. Conclusion These findings suggest that in comparison with MPA and Cya, an EVR and LD ‐CyA regimen lowers the risk of BKV viremia after kidney transplantation and favorably alters outcomes.