CMV infection, valganciclovir exposure, and the risk of BK viremia and associated nephropathy after kidney transplantation: Is there a link?

Background Immunomodulatory effects attributable to cytomegalovirus (CMV) would predispose to BK polyomavirus (BKPyV) infection after kidney transplantation (KT), although available evidence is conflicting. It has been suggested that (val)ganciclovir therapy may increase the risk of BKPyV viremia an...

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Published in:Transplant infectious disease 2021-08, Vol.23 (4), p.e13597-n/a
Main Authors: Rodríguez‐Goncer, Isabel, Ruiz‐Ruigómez, María, López‐Medrano, Francisco, Corbella, Laura, Polanco, Natalia, González Monte, Esther, San Juan, Rafael, Ruiz‐Merlo, Tamara, Parra, Patricia, Folgueira, Lola, Andrés, Amado, Aguado, José María, Fernández‐Ruiz, Mario
Format: Article
Language:English
Subjects:
Antiviral drugs
BK polyomavirus
Cytomegalovirus
Exposure
Ganciclovir
Immunomodulation
Infections
Kidney transplantation
Kidney transplants
Nephropathy
opportunistic infection
Prophylaxis
Risk
Survival
Therapy
valganciclovir
Viremia
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Summary:Background Immunomodulatory effects attributable to cytomegalovirus (CMV) would predispose to BK polyomavirus (BKPyV) infection after kidney transplantation (KT), although available evidence is conflicting. It has been suggested that (val)ganciclovir therapy may increase the risk of BKPyV viremia and BKPyV‐associated nephropathy (BKPyVAN) as a result of drug‐induced T‐cell impairment. Methods We investigated whether CMV replication and/or (val)ganciclovir exposure (either as prophylaxis or treatment) were associated with the development of BKPyV viremia or BKPyVAN in a prospective cohort of 399 KT recipients. CMV infection (any level or high‐level viremia and area under the curve of DNAemia) and (val)ganciclovir exposure (any duration of therapy and cumulative days of treatment) during the first post‐transplant year were explored through separate landmark survival analyses. Results Cumulative incidence of BKPyV viremia and BKPyVAN after a median follow‐up of 551 days was 23.1% and 2.5%, respectively. One‐year rates of CMV infection and (val)ganciclovir therapy were 47.4% and 54.1%, respectively. No differences were observed in BKPyV viremia‐ or BKPyVAN‐free survival according to previous CMV infection or (val)ganciclovir exposure in any of the landmark analyses. Adjusted Cox models confirmed this lack of association. Conclusion Our findings do not confirm the existence of a relevant impact of CMV infection or (val)ganciclovir therapy on the risk of post‐transplant BKPyV events.
ISSN:1398-2273
1399-3062
DOI:10.1111/tid.13597