Aggressive Immunosuppression Minimization Shortens BK Viremia, Does Not Improve Outcome, but Increases the Risk of De Novo Donor Specific Antibodies in Kidney Recipients
1Nephrology and Kidney Transplantation, Necker Hospital, Paris, France
2Nephrology, University Hosputal Saint-Luc, Brussels, Belgium
3Virology, Necker Hospital, Paris, France
4Pathology, Necker Hospital, Paris, France.
Meeting: 2018 American Transplant Congress
Abstract number: 136
Keywords: Polyma virus
Session Information
Session Name: Concurrent Session: Kidney Transplant Goes Viral
Session Type: Concurrent Session
Date: Sunday, June 3, 2018
Session Time: 4:30pm-6:00pm
Presentation Time: 5:30pm-5:42pm
Location: Room 606/607
Background: Immunosuppression (IS) minimization is the gold-standard treatment of BK virus (BKV) viremia in kidney transplant recipients (KTRs). However, the optimal approach to IS reduction remains unclarified.
Methodology: At a single high-volume center, we retrospectively compared two consecutive strategies of IS minimization in 111 KTRs with sustained viremia: a more gradual tapering group (n=57) before 2012 and a rapid tapering group (n=54) after 2012.
Results: Compared to the gradual tapering group, the rapid tapering group had a higher number (median [IQR]) of plasma BKV screenings during the first year (15 [12-20] vs. 3 [2-10], P<0.001) and an earlier diagnosis of viremia after transplantation (99 [74-181] vs 133 [86-370] days, P=0.042). At viremia diagnosis, the daily dose of mycophenolic acid (MPA) and tacrolimus trough levels (Tac T0) were similar in the gradual vs. rapid tapering groups (p=0.103 and 0.917, respectively). However, after viremia, the dose of MPA at 1 month (P=0.002) and 3 months (P=0.005), and Tac T0 at 1 month (P=0.030) and 3 months (P=0.006) were lower in the rapid taper vs. the gradual taper group. This rapid IS minimization shortened BKV viremia (105 [71-240] vs. 384 [197-521] days, P<0.001) without impacting patient and graft survivals (p=0.950 and 0.760, respectively). One year after the onset of BKV viremia, estimated glomerular filtration rate was similar (p=0.527). However, if acute rejection-free survivals after viremia were also similar in both groups (P=0.571, log-rank test), the rapid taper group showed an accelerated development of de novo donor-specific antibodies (dnDSAs) (P<0.001, log-rank test). Multivariate Cox analysis revealed that basiliximab compared to Thymoglobulin induction (hazard ratio [HR], 3.279; 95% confidence interval (CI), 1.388-7.746; P=0.007) and the rapid taper strategy (HR, 6.999; 95% CI, 2.360-20.763; P<0.001) as independently associated with dnDSAs.
Conclusion: A more aggressive minimization of IS shortens BKV viremia without clear benefit for medium-term renal outcomes but increased incidence of dnDSAs.
CITATION INFORMATION: Devresse A., Tinel C., Vermorel A., Snanoudj R., Morin L., Avettand-Fenoel V., Amrouche L., Scemla A., Zuber J., Legendre C., Rabant M., Anglicheau D. Aggressive Immunosuppression Minimization Shortens BK Viremia, Does Not Improve Outcome, but Increases the Risk of De Novo Donor Specific Antibodies in Kidney Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Devresse A, Tinel C, Vermorel A, Snanoudj R, Morin L, Avettand-Fenoel V, Amrouche L, Scemla A, Zuber J, Legendre C, Rabant M, Anglicheau D. Aggressive Immunosuppression Minimization Shortens BK Viremia, Does Not Improve Outcome, but Increases the Risk of De Novo Donor Specific Antibodies in Kidney Recipients [abstract]. https://atcmeetingabstracts.com/abstract/aggressive-immunosuppression-minimization-shortens-bk-viremia-does-not-improve-outcome-but-increases-the-risk-of-de-novo-donor-specific-antibodies-in-kidney-recipients/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress