Conversion to mTOR-inhibitors with calcineurin inhibitor elimination or minimization reduces urinary polyomavirus BK load in kidney transplant recipients

Chieh Li Yen, Ya Chung Tian, Hsin Hsu Wu, Cheng Hao Weng, Yung Chang Chen, Kun Hua Tu, Shou Hsuan Liu, Cheng Chia Lee, Ping Chin Lai, Ji Tseng Fang, Cheng Chieh Hung, Chih Wei Yang, Yi Jung Li*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

9 Scopus citations

Abstract

Background/purpose: Polyomavirus BK (BKV) reactivation causes allograft dysfunction in some kidney transplant recipients. The use of mammalian target of rapamycin (mTOR) inhibitor-based immunotherapy is associated with a lower incidence of polyomavirus-associated nephropathy compared with other immunosuppressants. This retrospective study assessed whether conversion to mTOR inhibitor-based immunotherapy directly reduced urinary BKV load. Methods: A total of 63 kidney recipients were divided into mTOR inhibitor-conversion (21 patients) and nonconversion (42 patients) groups. Urinary BKV loads were determined before and at least 6 months after the conversion. Results: The results demonstrated that urinary BKV titer was significantly reduced in the conversion group (3.94 ± 0.43 copies (log)/mL to 2.49 ± 0.19 copies (log)/mL) and remained unaltered in the nonconversion group (3.19 ± 0.20 copies (log)/mL to 2.90 ± 0.20 copies (log)/mL). In addition, the percentage of patients with reduced urinary BKV load was significantly higher in the conversion group (76.2% vs. 42.9%). The estimated glomerular filtration rate after 24 months mTOR inhibitor conversion was significantly increased compared with that in the nonconversion group. Conversion to mTOR-inhibitor-based immunotherapy was the only factor associated with an increase in estimated glomerular filtration rate. Conclusion: This study reveals an association of conversion to mTOR-inhibitor-based immunotherapy with the reduction of urinary BKV load.

Original languageEnglish
Pages (from-to)539-546
Number of pages8
JournalJournal of the Formosan Medical Association
Volume115
Issue number7
DOIs
StatePublished - 01 07 2016

Bibliographical note

Publisher Copyright:
© 2016 Formosan Medical Association. Published by Elsevier Taiwan LLC.

Keywords

  • Kidney transplantation
  • Mammalian target of rapamycin
  • Polyomavirus BK
  • Viruria

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