201. Cytomegalovirus prevention strategies and the risk of BK polyomavirus viremia and nephropathy.
- Author
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Reischig T, Kacer M, Hes O, Machova J, Nemcova J, Lysak D, Jindra P, Pivovarcikova K, Kormunda S, and Bouda M
- Subjects
- Adult, BK Virus, Cytomegalovirus, Female, Graft Survival, Humans, Kidney Failure, Chronic complications, Male, Middle Aged, Multivariate Analysis, Premedication, Proportional Hazards Models, Prospective Studies, Randomized Controlled Trials as Topic, Risk Factors, Treatment Outcome, Valacyclovir therapeutic use, Valganciclovir therapeutic use, Cytomegalovirus Infections prevention & control, Kidney Failure, Chronic surgery, Kidney Transplantation adverse effects, Polyomavirus Infections virology, Tumor Virus Infections prevention & control, Viremia etiology
- Abstract
Polyomavirus BK (BKV) is the cause of polyomavirus-associated nephropathy resulting in premature graft loss. There are limited data regarding the role of cytomegalovirus (CMV) infection and its prevention in developing BKV viremia and PVAN. In a prospective study, we analyzed 207 consecutive renal transplant recipients previously enrolled in 2 randomized trials evaluating different CMV prevention regimens with routine screening for BKV and CMV. Of these, 59 received valganciclovir and 100 valacyclovir prophylaxis; 48 patients were managed by preemptive therapy. At 3 years, the incidence of BKV viremia and PVAN was 28% and 5%, respectively. CMV DNAemia developed in 55% and CMV disease in 6%. Both BKV viremia (42% vs 23% vs 21%, P = .006) and PVAN (12% vs 2% vs 2%, P = .011) were increased in patients treated with valganciclovir prophylaxis compared to valacyclovir and preemptive therapy. Using multivariate Cox proportional hazard regression, valganciclovir prophylaxis was independent predictor of BKV viremia (hazard ratio [HR] = 2.38, P = .002) and PVAN (HR = 4.73, P = .026). In contrast, the risk of subsequent BKV viremia was lower in patients with antecedent CMV DNAemia (HR = 0.50, P = .018). These data suggest valganciclovir prophylaxis may be associated with increased risk of BKV viremia and PVAN. CMV DNAemia did not represent a risk for BKV., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2019
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