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Abstract: FR-PO821

The Impact of Mycophenolate Dosing on BK Viremia in Low-Risk Kidney Transplant (KT) Recipients

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Thomas, Dylan, Erie County Medical Center, Buffalo, New York, United States
  • Hua, Shuangcheng, University at Buffalo, Buffalo, New York, United States
  • Von Visger, Jon R., University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, United States
  • Shah, Vaqar H., University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, United States
  • Kareem, Samer, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, United States
  • Ott, Michael C., Erie County Medical Center, Buffalo, New York, United States
  • Jalal, Kabir, University at Buffalo, Buffalo, New York, United States
  • Chang, Shirley Shwu-Shiow, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, United States
Background

BK polyomavirus infection affects 10-60% of KT recipients. Risk factors include degree of immuosuppression, and allograft rejection. Management of BK viremia includes reduction of immunosuppression with close monitoring for rejection. The data is limited in MMF dosing at time of KT & effect on BK.

Methods

This is a single-center, retrospective study examining effect of MMF dosing in low-risk (CPRA <20%, non-Black) KT recipients on BK viremia at Erie County Medical Center between 8/2019-8/2021. Per protocol, MMF dosing was reduced from 750 mg BID (Higher MMF group) to 500 mg BID (Lower MMF group) for low-risk KT recipients on 8/2020. We performed chart review one-year prior & one-year post 8/2020. Exclusion criteria: multiorgan transplants, CPRA ≥20%, Black race, not on MMF. All had serum BK PCR at 2 weeks, monthly x 1-year, then 6 months x 2-years post-transplant. For those with BK viremia, MMF reduction was per clinician discretion, dosing was recorded with time. Primary outcome: BK viremia rate; Secondary outcome: biopsy-confirmed acute rejection rate.

Results

There were 75 in the Higher MMF group, and 62 in the Lower MMF group. Clinical characteristics were similar (age, gender, race, BMI, cPRA, KDPI, EPTS, type of KT). All received thymoglobulin induction (3 mg/kg) and steroid. MMF dosing in the Higher MMF group was 1527 mg/day after transplant, 1510 at month 1, 1389 at month 3 post-transplant; MMF dose in the Lower MMF group was 1082 mg/day after transplant, 1103 at month 1, 1123 at month 3 post-transplant (p<0.01,p<0.01, p=0.005 respectively).Other immuosuppressions, eGFR, allograft loss, and death were not different. BK viremia rate was 32% in the Higher MMF group vs. 16% in the Lower MMF group (p=0.052).Of those with BK viremia, BK duration was not different, however, time from transplant to BK onset was shorter in the Lower MMF group (91 days vs. 190 days, p=0.019). Biopsy confirmed acute rejection rate was not different. There were 16 patients (21%) who develop ACR in the Higher MMF group; 10 patients (14.5%) developed ACR and 1 patient (1.6%) with AMR in the Lower MMF group (p=NS).

Conclusion

Lower MMF at time of KT in low-risk KT recipients tend to have lower BK viremia rate and has no effect in acute rejection rate. More and larger studies are needed to confirm above findings.

Funding

  • Other NIH Support