PMID- 27615506
OWN - NLM
STAT- MEDLINE
DCOM- 20170804
LR  - 20211204
IS  - 1399-3062 (Electronic)
IS  - 1398-2273 (Linking)
VI  - 18
IP  - 6
DP  - 2016 Dec
TI  - Preemptive reduction of immunosuppression upon high urinary polyomavirus loads 
      improves patient survival without affecting kidney graft function.
PG  - 872-880
LID - 10.1111/tid.12603 [doi]
AB  - BACKGROUND: Polyomavirus (PV) is a major cause of kidney graft disease. 
      Monitoring by polymerase chain reaction (PCR) on blood is currently recommended. 
      In order to avoid irreversible lesions, we investigated the clinical impact of 
      preemptive reduction of immunosuppression (IS) in kidney transplant recipients 
      (KTR) upon detection of high urinary PV (Upv) load, including BK virus and JC 
      virus. MATERIAL AND METHODS: From 2000 to 2011, in our single center, 789 
      consecutive KTR were distributed into 4 groups, according to the maximal Upv 
      levels (by PCR) during the first year and the therapeutic option: (A) Upv <10(4) 
      copies (cp)/mL (n=573), (B) >/=10(4) Upv <10(7) cp/mL (n=100), and (C) Upv >/=10(7) 
      cp/mL (n=116); in group C, the IS drug doses were reduced in subgroup Ca (n=102) 
      only, as 14 patients (subgroup Cb) were at risk for graft rejection. RESULTS: The 
      preemptive reduction of IS (group Ca) increased patient survival as compared with 
      all other groups (P<.05), did not modify graft function, and increased graft 
      survival vs group A (risk ratio: 5.7, confidence interval: 1.8-18.1, P=.003). 
      Differences for risk factors are as follows (groups Ca vs A): incidence of human 
      leukocyte antigen (HLA) immunization (>5% panel reactive antibodies): 3% vs 8% 
      (P=.05), number of HLA mismatches: 2.7 vs 2.5 (P=.049), and incidence of acute 
      rejection: 9.8% vs 24.2% (P=.005). PV-associated nephropathy occurred only in 
      group Ca (2% of total grafts) without effect on patient or graft outcome. 
      CONCLUSION: The reduction of IS in patients with high Upv loads is beneficial for 
      patient survival and does not affect graft survival or graft function.
CI  - (c) 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
FAU - Broeders, Emine Nilufer
AU  - Broeders EN
AUID- ORCID: 0000-0001-5377-9335
AD  - Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires 
      de Bruxelles, Hopital Erasme, Brussels, Belgium.
FAU - Hamade, Anwar
AU  - Hamade A
AD  - Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires 
      de Bruxelles, Hopital Erasme, Brussels, Belgium.
FAU - El Mountahi, Fadoua
AU  - El Mountahi F
AD  - Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires 
      de Bruxelles, Hopital Erasme, Brussels, Belgium.
FAU - Racape, Judith
AU  - Racape J
AD  - Research Center of Biostatistics, Epidemiology and Clinical Research, School of 
      Public Health, Universite Libre de Bruxelles, Brussels, Belgium.
FAU - Hougardy, Jean-Michel
AU  - Hougardy JM
AD  - Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires 
      de Bruxelles, Hopital Erasme, Brussels, Belgium.
FAU - Le Moine, Alain
AU  - Le Moine A
AD  - Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires 
      de Bruxelles, Hopital Erasme, Brussels, Belgium.
FAU - Vereerstraeten, Pierre
AU  - Vereerstraeten P
AD  - Department of Nephrology, Dialysis and Transplantation, Cliniques Universitaires 
      de Bruxelles, Hopital Erasme, Brussels, Belgium.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20161020
PL  - Denmark
TA  - Transpl Infect Dis
JT  - Transplant infectious disease : an official journal of the Transplantation 
      Society
JID - 100883688
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - BK Virus/*drug effects/isolation & purification
MH  - Female
MH  - Graft Rejection/*epidemiology/immunology/virology
MH  - Graft Survival/*drug effects
MH  - HLA Antigens/immunology
MH  - Humans
MH  - Immunosuppression Therapy/*adverse effects/methods
MH  - Immunosuppressive Agents/*administration & dosage/therapeutic use
MH  - JC Virus/*drug effects/isolation & purification
MH  - Kidney Diseases/epidemiology/urine/virology
MH  - Kidney Transplantation/*adverse effects
MH  - Male
MH  - Middle Aged
MH  - Polyomavirus Infections/epidemiology/urine/virology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Transplant Recipients/statistics & numerical data
MH  - Treatment Outcome
MH  - Tumor Virus Infections/epidemiology/urine/virology
MH  - Viral Load/*drug effects
MH  - Viremia/*urine/virology
OTO - NOTNLM
OT  - graft function
OT  - immunosuppression
OT  - kidney transplantation
OT  - polyomavirus
OT  - survival
EDAT- 2016/10/21 06:00
MHDA- 2017/08/05 06:00
CRDT- 2016/09/13 06:00
PHST- 2015/12/20 00:00 [received]
PHST- 2016/04/16 00:00 [revised]
PHST- 2016/05/07 00:00 [revised]
PHST- 2016/06/12 00:00 [revised]
PHST- 2016/06/29 00:00 [accepted]
PHST- 2016/10/21 06:00 [pubmed]
PHST- 2017/08/05 06:00 [medline]
PHST- 2016/09/13 06:00 [entrez]
AID - 10.1111/tid.12603 [doi]
PST - ppublish
SO  - Transpl Infect Dis. 2016 Dec;18(6):872-880. doi: 10.1111/tid.12603. Epub 2016 Oct 
      20.