Nephrotoxicity of calcineurin inhibitors as a risk factor for BK polyomavirus replication after kidney transplantation.
BK polyomavirus-associated nephropathy (PyVAN) is responsible for a significant percentage of transplanted kidneys prematurely terminating their function. Its occurrence is closely related to the intensity of immunosuppressive therapy. In a group of 161 newly transplanted patients, we prospectively evaluated 457 protocol renal biopsies performed within the first year after transplantation. Using the calcineurin inhibitors (CI) nephrotoxicity score, the incidence of nephrotoxicity was monitored as a manifestation of excessive immunosuppression. Findings were correlated with clinical evidence of active BK polyomavirus (BKPyV) replication and PyVAN. Compared to the normal histology, nephrotoxicity was associated with more frequent BKPyV viremia and viruria (p = .01 and p < .01, respectively) and more common occurrence of PyVAN. The persistence of toxicity in the subsequent biopsy proved to be a negative risk factor of viremia and viruria (p = .03 and p < .01, respectively), independently of the initial BKPyV status. Toxicity could also be used as a predictor of viremia and viruria (p = .04 and p < .01, respectively) even in the absence of viral replication at the time of initial biopsy. The early histological manifestation of CI nephrotoxicity was associated with significant BKPyV reactivation in the risky first posttransplant year.
['Krejčí|Karel|K|0000-0003-0645-3433', 'Tichý|Tomáš|T|', 'Bednaříková|Jana|J|', 'Bartková|Margita|M|', 'Žamboch|Kamil|K|', 'Orság|Jiří|J|', 'Zadražil|Josef|J|']
D000293:Adolescent D000328:Adult D000368:Aged D001739:BK Virus D001706:Biopsy D065095:Calcineurin Inhibitors D005260:Female D006801:Humans D007165:Immunosuppression Therapy D015994:Incidence D007668:Kidney D007674:Kidney Diseases D016030:Kidney Transplantation D008297:Male D008875:Middle Aged D027601:Polyomavirus Infections D011446:Prospective Studies D012307:Risk Factors D066027:Transplant Recipients D014412:Tumor Virus Infections D014766:Viremia D014779:Virus Replication D055815:Young Adult
nephrotoxicity calcineurin inhibitors kidney transplantation BK polyomavirus-associated nephropathy protocol biopsy