The influence of immunosuppressive agents on BK virus risk following kidney transplantation, and implications for choice of regimen.
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The influence of immunosuppressive agents on BK virus risk following kidney transplantation, and implications for choice of regimen. / Suwelack, Barbara; Malyar, Viola; Koch, Martina; Sester, Martina; Sommerer, Claudia.
in: Transplant Rev (Orlando), Jahrgang 26, Nr. 3, 3, 2012, S. 201-211.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - The influence of immunosuppressive agents on BK virus risk following kidney transplantation, and implications for choice of regimen.
AU - Suwelack, Barbara
AU - Malyar, Viola
AU - Koch, Martina
AU - Sester, Martina
AU - Sommerer, Claudia
PY - 2012
Y1 - 2012
N2 - The increasing incidence of BK-associated nephropathy following kidney transplantation has prompted an examination of strategies for risk reduction and management through immunosuppression manipulation. Evidence from retrospective and prospective studies suggests that BK viruria and viremia, and the need for BK virus treatment, are higher with tacrolimus than cyclosporine. Combined therapy with tacrolimus and mycophenolic acid may be associated with a particularly higher risk of BK infection, but data are conflicting as to whether mycophenolic acid per se is an independent risk factor. The incidence of BK-related events may be reduced in patients receiving mTOR inhibitors (everolimus or sirolimus) with cyclosporine vs a calcineurin inhibitor with mycophenolic acid. De novo immunosuppression regimens that avoid rabbit antithymocyte globulin and tacrolimus, particularly tacrolimus with mycophenolic acid, may be advantageous, whereas low-exposure cyclosporine with an mTOR inhibitor appears a favorable option. Routine screening for BK infection during the first 2 years posttransplant is recommended to allow preemptive modification of the immunosuppressive regimen. In patients at high risk of BK virus infection, appropriate de novo immunosuppression or very early conversion to an mTOR inhibitor to facilitate reduction or discontinuation of calcineurin inhibitors or antimetabolites should be considered. Extensive further research into optimal avoidance, screening, and treatment strategies is required.
AB - The increasing incidence of BK-associated nephropathy following kidney transplantation has prompted an examination of strategies for risk reduction and management through immunosuppression manipulation. Evidence from retrospective and prospective studies suggests that BK viruria and viremia, and the need for BK virus treatment, are higher with tacrolimus than cyclosporine. Combined therapy with tacrolimus and mycophenolic acid may be associated with a particularly higher risk of BK infection, but data are conflicting as to whether mycophenolic acid per se is an independent risk factor. The incidence of BK-related events may be reduced in patients receiving mTOR inhibitors (everolimus or sirolimus) with cyclosporine vs a calcineurin inhibitor with mycophenolic acid. De novo immunosuppression regimens that avoid rabbit antithymocyte globulin and tacrolimus, particularly tacrolimus with mycophenolic acid, may be advantageous, whereas low-exposure cyclosporine with an mTOR inhibitor appears a favorable option. Routine screening for BK infection during the first 2 years posttransplant is recommended to allow preemptive modification of the immunosuppressive regimen. In patients at high risk of BK virus infection, appropriate de novo immunosuppression or very early conversion to an mTOR inhibitor to facilitate reduction or discontinuation of calcineurin inhibitors or antimetabolites should be considered. Extensive further research into optimal avoidance, screening, and treatment strategies is required.
KW - Humans
KW - Risk Factors
KW - TOR Serine-Threonine Kinases/antagonists & inhibitors
KW - Kidney Transplantation
KW - Calcineurin/antagonists & inhibitors
KW - Virus Replication/drug effects
KW - Antilymphocyte Serum/pharmacology
KW - BK Virus/drug effects/physiology
KW - Glucocorticoids/pharmacology
KW - Immunosuppressive Agents/pharmacology/therapeutic use
KW - Mycophenolic Acid/pharmacology
KW - Polyomavirus Infections/diagnosis/drug therapy/etiology/virology
KW - Tacrolimus/pharmacology
KW - Tumor Virus Infections/diagnosis/drug therapy/etiology/virology
KW - Virus Activation/drug effects
KW - Humans
KW - Risk Factors
KW - TOR Serine-Threonine Kinases/antagonists & inhibitors
KW - Kidney Transplantation
KW - Calcineurin/antagonists & inhibitors
KW - Virus Replication/drug effects
KW - Antilymphocyte Serum/pharmacology
KW - BK Virus/drug effects/physiology
KW - Glucocorticoids/pharmacology
KW - Immunosuppressive Agents/pharmacology/therapeutic use
KW - Mycophenolic Acid/pharmacology
KW - Polyomavirus Infections/diagnosis/drug therapy/etiology/virology
KW - Tacrolimus/pharmacology
KW - Tumor Virus Infections/diagnosis/drug therapy/etiology/virology
KW - Virus Activation/drug effects
M3 - SCORING: Journal article
VL - 26
SP - 201
EP - 211
IS - 3
M1 - 3
ER -
