Is Mycophenolic Acid AUC a Good Pronostic Factor for BK Viremia?
Service de Néphrologie, CHRU Clemenceau, Caen, France
Service de Virologie, CHRU Clemenceau, Caen, France
Service de Pharmacologie, CHRU Cote de Nacre, Caen, France
Meeting: 2013 American Transplant Congress
Abstract number: C1369
Background: BK virus can induce severe impairment of graft function after kidney transplantation. Many studies have evaluated the best strategy to prevent BK-induced interstitial nephritis. Overimmunosuppression is largely advocated. Thus, several risk factors are already known but the impact of Mycophenolate Mofetil (MMF) exposure is not clear since area under curve (AUC) is not routinely monitored and few data are available about high mycophenolic acid AUC and its side effects. In this study, we try to detect whether high MMF exposure is a BK viremia risk factor.
Methods: we screened 259 de novo kidney recipients who were treated by MMF at least during the first 3 months during a retrospective study from july 2006 to june 2011 with 1-year follow-up. Their immunosuppressive treatment was composed by MMF, tacrolimus or cyclosporine associated with prednisone. Blood and urine samples were performed for BK virus at 1, 3, 6 and 12 months (M1, M3, M6, M12) after transplantation. In the same time, tacrolimus or cyclosporine trough levels and area under the curve (AUC) MMF were monitored. We compared patients’ treatment and characteristics with patients with BK viremia (group 1) or without (group 2).
Results: 23 patients (9 %) developed BK viremia and 80 developed viruria (31 %). BK viremia occurred at day 160 and BK viruria at day 109 for group 1 whereas BK viruria occurred at day 152 for patients with BK viruria only.
Concerning treatment, mean AUC and daily MMF drug dose are not significantly different between the two groups at M1, M3. Tacrolimus and cyclosporine trough levels were similar.
Nevertheless recipients are older in group 1 (58±12 vs 50±14 years, p<0,05). Male gender was a risk factor for BK viremia (21/23 vs 151/236, p<0,05). Furthermore focal segmental glomerulosclerosis seemed also to be a risk factor for BK viremia (4/23 vs 11/236, p<0,05).
Conclusion: High AUC and daily MMF drug dose do not seem to be a risk factor for BK viremia. Unmodifiable recipients’ characteristics seem to play a greater role than treatment since older age and male gender were associated with BK viremia. Interestingly, focal segmental glomerulosclerosis seemed to be associated with BK viremia after renal transplantation.
To cite this abstract in AMA style:
Lamy T, Ligny BHuraultde, Dina J, Debruyne D, Chatelet V, Lobbedez T, Ficheux M, Bouvier N. Is Mycophenolic Acid AUC a Good Pronostic Factor for BK Viremia? [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/is-mycophenolic-acid-auc-a-good-pronostic-factor-for-bk-viremia/. Accessed May 17, 2025.« Back to 2013 American Transplant Congress