Cytomegalovirus prevention strategies and the risk of BK polyomavirus viremia and nephropathy
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
Grant support
LO1503
National Sustainability Program I - International
Ministry of Education, Youth and Sports of the Czech Republic - International
Charles University Research Fund - International
CZ.02.1.01/0.0/0.0/16_019/0000787
Fighting INfectious Diseases - International
European Regional Development Fund - International
PubMed
31220412
DOI
10.1111/ajt.15507
PII: S1600-6135(22)09221-8
Knihovny.cz E-resources
- Keywords
- clinical research/practice, clinical trial, infection and infectious agents - viral: BK/JC/polyoma, infection and infectious agents - viral: cytomegalovirus (CMV), infectious disease, kidney transplantation/nephrology,
- MeSH
- Kidney Failure, Chronic complications surgery MeSH
- Cytomegalovirus Infections prevention & control MeSH
- Cytomegalovirus MeSH
- Adult MeSH
- Tumor Virus Infections prevention & control MeSH
- Middle Aged MeSH
- Humans MeSH
- Multivariate Analysis MeSH
- Polyomavirus Infections virology MeSH
- Premedication MeSH
- Graft Survival MeSH
- Proportional Hazards Models MeSH
- Prospective Studies MeSH
- Randomized Controlled Trials as Topic MeSH
- Risk Factors MeSH
- Kidney Transplantation adverse effects MeSH
- Valacyclovir therapeutic use MeSH
- Valganciclovir therapeutic use MeSH
- Viremia etiology MeSH
- BK Virus MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Valacyclovir MeSH
- Valganciclovir MeSH
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.
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