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Abstract: FR-PO1139

Cytomegalovirus Prevention Strategies and the Risk of BK Polyomavirus Viremia and Nephropathy

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Reischig, Tomas, Charles University Medical School and Teaching Hospital, Plzen, Czechia
  • Kacer, Martin, Charles University Medical School and Teaching Hospital, Plzen, Czechia
  • Hes, Ondrej, Charles University, Plzen, Czechia
  • Lysak, Daniel, University Hospital Pilsen, Pilsen, Czechia
  • Machová, Jana, Biomedical Centre, Faculty of Medicine in Pilsen, Pilsen, Czechia
  • Bouda, Mirko, Faculty Hospital Pilsen, Charles University, Plzen, Czechia
Background

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.

Methods

In a prospective study, we analyzed 207 consecutive renal transplant recipients previously enrolled to 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.

Results

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=0.006) and PVAN (12% vs. 2% vs. 2%, P=0.011) 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=0.002) and PVAN (HR=4.73, P=0.026). In contrast, the risk of subsequent BKV viremia was lower in patients with antecedent CMV DNAemia (HR=0.50, P=0.018).

Conclusion

These data suggest that valganciclovir prophylaxis is associated with increased risk of BKV viremia and PVAN. CMV DNAemia did not represent a risk for BKV.

Kaplan-Meier curves for the cumulative probability of freedom from (A) polyoma BKV viremia, and (B) polyomavirus-associated nephropathy based on cytomegalovirus prevention strategy. BKV, polyomavirus BK.

Funding

  • Government Support - Non-U.S.