A comparative analysis of clinical outcomes between conversion to mTOR inhibitor and calcineurin inhibitor reduction in managing BK viremia among kidney transplant patients

• Published in: Scientific reports 2024-06, Vol.14 (1), p.12855-10
• Main Authors: Cho, Ara, Park, Sunghae, Han, Ahram, Ha, Jongwon, Park, Jae Berm, Lee, Kyo Won, Min, Sangil
• Format: Article
• Language: English
• Subjects: 631/326/596; 692/699/255/2514; Adult; Aged; Biopsy; BK Virus; Calcineurin inhibitors; Calcineurin Inhibitors - therapeutic use; Comparative analysis; Female; Graft rejection; Graft Rejection - drug therapy; Graft Rejection - prevention & control; Humanities and Social Sciences; Humans; Immunosuppressive Agents - therapeutic use; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Male; Middle Aged; multidisciplinary; Nephropathy; Patients; Polyomavirus Infections - drug therapy; Population studies; Rapamycin; Renal function; Republic of Korea; Retrospective Studies; Science; Science (multidisciplinary); Sirolimus - therapeutic use; Statistical analysis; Tacrolimus; Tacrolimus - therapeutic use; TOR protein; TOR Serine-Threonine Kinases - antagonists & inhibitors; TOR Serine-Threonine Kinases - metabolism; Treatment Outcome; Tumor Virus Infections - drug therapy; Tumor Virus Infections - virology; Viral Load - drug effects; Viremia; Viremia - drug therapy
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-60695-2

BK virus-associated nephropathy (BKVAN) exerts a substantial impact on allograft survival, however, the absence of robust clinical evidence regarding treatment protocols adds to the complexity of managing this condition. This study aimed to compare the two treatment approaches. The study population consisted of patients who underwent kidney transplantation between January 2016 and June 2020 at two tertiary hospitals in Korea. Patients diagnosed with BK viremia were evaluated based on their initial viral load and the treatment methods. The ‘Reduction group’ involved dose reduction of tacrolimus while the ‘Conversion group’ included tacrolimus discontinuation and conversion to sirolimus. A total of 175 patients with an initial viral load (iVL) ≥ 3 on the log10 scale were evaluated within two iVL intervals (3–4 and 4–5). In the iVL 4–5 interval, the Reduction group showed potential effectiveness in terms of viral clearance without statistically significant differences. However, within the iVL 3–4 interval, the Reduction group demonstrated superior viral clearance and a lower incidence of biopsy-proven acute rejection (BPAR) than the Conversion group. The renal function over 12 months after BKV diagnosis showed no statistically significant difference. Reducing tacrolimus compared to converting to mTORi would be a more appropriate treatment approach for BK viral clearance in kidney transplantation. Further research is warranted in a large cohort of patients.