Introduction

BK viremia is a common complication following kidney transplantation. In vitro data suggest that inhibition of the mTOR–SP6-kinase pathway prevents expression of early viral genes necessary for replication. We hypothesized that the utilization of an mTOR inhibitor (mTORI) instead of MMF as the antiproliferative agent in combination with belatacept would reduce the risk of BK viremia.

Methods

Retrospective analysis of 58 kidney transplant recipients receiving de novo belatacept who were either converted from MMF to everolimus at 30 days post-transplant as part of a clinical protocol (“Everolimus group”, n=43) or remained on MMF (“MMF group”, n=15). All patients were screened with monthly quantitative BKV DNA PCR in plasma for the first 6 months post-transplant. We compared the incidence of BK viremia at 6 months in the two groups using Pearson's chi-squared test.

Results

Demographic and clinical characteristics are listed in Table 1. The incidence of BK viremia at 6 months was not significantly different between the 2 groups. Viremia appeared later in the everolimus group than in the MMF group (mean POD 117 vs. 63; P=0.16) but this difference was not statistically significant. There were no differences in the peak viral load or time to peak viremia between the 2 groups.

Conclusion

No differences were seen in the incidence or severity of BK viremia among kidney transplant recipients on everolimus vs. MMF in combination with belatacept. There was a non-significant trend toward later onset of viremia in the everolimus group. Additional follow up is ongoing to examine outcomes at 1 year post-transplant.

CITATION INFORMATION: Larsen C, Alseiari M, Chandran S, Vincenti F, Wojciechowski D. Impact of Everolimus Added to a De Novo Belatacept Regimen on the Risk of BK Viremia After Kidney Transplant. Am J Transplant. 2017;17 (suppl 3).

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