Everolimus-Based Immunosuppression Therapy for BK Virus Nephropathy

Abstract Background Mammalian target of rapamycin inhibitors (mTOR-i) have been proposed as possible immunosuppressants of choice in BK virus nephropathy (BKN) because of their antiviral capacity. On this basis, in 2007, our Service proposed a conversion to everolimus (EVE)-based therapy from calcin...

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Published in:Transplantation proceedings 2015, Vol.47 (1), p.57-61
Main Authors: Polanco, N, González Monte, E, Folgueira, M.D, Morales, E, Gutiérrez Martínez, E, Bengoa, I, Hernández, A, Morales, J.M, Praga, M, Andrés, A
Format: Article
Language:English
Subjects:
Adult
BK Virus
Calcineurin Inhibitors
Everolimus
Female
Graft Survival
Humans
Immunosuppression
Immunosuppressive Agents - therapeutic use
Kidney Diseases - diagnosis
Kidney Diseases - epidemiology
Kidney Diseases - therapy
Kidney Transplantation
Male
Middle Aged
Polyomavirus Infections - diagnosis
Polyomavirus Infections - epidemiology
Polyomavirus Infections - prevention & control
Prospective Studies
Sirolimus - analogs & derivatives
Sirolimus - therapeutic use
Surgery
Tacrolimus - therapeutic use
Viral Load
Viremia - diagnosis
Viremia - etiology
Viremia - prevention & control
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Summary:Abstract Background Mammalian target of rapamycin inhibitors (mTOR-i) have been proposed as possible immunosuppressants of choice in BK virus nephropathy (BKN) because of their antiviral capacity. On this basis, in 2007, our Service proposed a conversion to everolimus (EVE)-based therapy from calcineurin inhibitors with an anti–calcineurin-free therapy protocol in those patients diagnosed of BKN. Methods A prospective, single-center case series study was performed. Fifteen cases of BKN were diagnosed from 2007 to the end of 2010. According to our protocol, immunosuppressant treatment was modified in 9 of these patients with suspension of mycophenolate and conversion from tacrolimus to EVE. Results The renal function achieved by our patients after the transplantation was excellent. Mean serum creatinine (sCr) achieved was 1.16 ± 0.2 mg/dL. Evolution of the renal function after BKN diagnosis and conversion to mTOR-i was positive in all the patients. sCr on diagnosis was 1.85 ± 0.22 mg/dL, sCr at the point in time of conversion to EVE was 2 ± 0.21 mg/dL, and final sCr of the follow-up was 1.6 ± 0.39 mg/dL ( P  = .05). BK viremia became negative in 5 of our patients and decreased more than 95% in the remaining 4. None of the patients had an acute rejection episode after the change of immunosuppressant. Conclusions Conversion to mTOR-i–based therapy could provide an added benefit in BKN and could be an effective strategy for the decrease of the viremia and increase of graft survival in selected patients.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2014.11.008