Pilot conversion trial from mycophenolic acid to everolimus in ABO-incompatible kidney-transplant recipients with BK viruria and/or viremia

• Published in: Transplant international Vol. 29; no. 3; p. 315
• Main Authors: Belliere, Julie, Kamar, Nassim, Mengelle, Catherine, Allal, Asma, Sallusto, Federico, Doumerc, Nicolas, Game, Xavier, Congy-Jolivet, Nicolas, Esposito, Laure, Debiol, Benedicte, Rostaing, Lionel
• Format: Journal Article
• Language: English
• Published: England 01-03-2016
• Subjects: ABO Blood-Group System - immunology; Adult; Aged; BK Virus; Everolimus - administration & dosage; Everolimus - adverse effects; Female; Humans; Immunosuppression - methods; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Kidney Function Tests; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid - administration & dosage; Pilot Projects; Polyomavirus Infections; Retrospective Studies; Tacrolimus - administration & dosage; Tumor Virus Infections; Viremia; Young Adult; ABO-incompatible transplant recipient; everolimus; BK virus; kidney transplantation; mycophenolic acid
• ISSN: 1432-2277
• DOI: 10.1111/tri.12718

Immunosuppression using everolimus (EVR) plus low-dose tacrolimus (Tac) is commonly used in organ transplantation. EVR has potential antiviral effects. Herein, the long-term outcomes and impacts of Tac-EVR on the BK virus are reported in ABO-incompatible kidney-transplant recipients. The initial immunosuppressive regimen combined steroids, Tac, and mycophenolic acid (MPA). At a median of 141 (34-529) days post-transplantation, seven stable ABO-incompatible kidney-transplant recipients were converted from MPA to EVR because of active BK replication, and compared with a reference group of fourteen ABO-incompatible patients receiving classical Tac plus MPA. At 1 month before conversion, at 1, 3 months after, and at last follow-up, clinical and biological parameters were monitored. The median time from conversion to the last follow-up was 784 (398-866) days. Conversion to EVR caused no change to rejection episodes or immunological status (isoagglutinin titers, anti-HLA antibodies). At last follow-up, median eGFR was similar in the Tac-MPA versus Tac-EVR group (40 [range: 14-56] vs. 54.5 ml/min/1.73 m(2) [range: 0-128], P = 0.07). The major adverse event was dyslipidemia. Interestingly, conversion from MPA to EVR decreased BK viral load in five patients. ABO-incompatible kidney-transplant recipients with an active BK virus infection may benefit from conversion to EVR.