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Accepted Manuscript

The therapeutic effect of switching from tacrolimus to low-dose cyclosporine A in renal transplant recipients with BK virus nephropathy

Xu-Tao Chen, Jun Li, Rong-Hai Deng, Shi-Cong Yang, Yan-Yang Chen, Pei-Song Chen, Ze-Yuan Wang, Yang Huang, Chang-Xi Wang, Gang Huang
Bioscience Reports Feb 08, 2019, BSR20182058; DOI: 10.1042/BSR20182058
Xu-Tao Chen
Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Jun Li
Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Rong-Hai Deng
Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Shi-Cong Yang
Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Yan-Yang Chen
Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Pei-Song Chen
Department of clinical laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Ze-Yuan Wang
Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
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Yang Huang
Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Chang-Xi Wang
Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Gang Huang
Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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  • For correspondence: huanggang_791021@163.com
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Abstract

Background: There is no effective therapy for BK virus nephropathy (BKVN). Cyclosporine A (CsA) has a lower immunosuppressive effect than tacrolimus. In vitro studies have shown that CsA inhibits BK virus (BKV) replication. This study aimed to evaluate the effectiveness of switching from tacrolimus to low-dose CsA in renal transplant recipients with BKVN.

Methods: Twenty-four patients diagnosed with BKVN between January 2015 and December 2016 were included. Tacrolimus was switched to low-dose CsA, and patients were followed for 24 months. Primary endpoints were BKV clearance in blood and graft. Secondary endpoints were urine specific gravity, serum creatinine, and graft loss.

Results: The viremia in all patients cleared at a mean of 2.7±2.0 months after switching to CsA. Urine specific gravity at 3 months after switching to CsA increased significantly compared to that at diagnosis ( P = 0.002). The timing and trend of urine specific gravity increase was consistent with the timing and trend of blood and urine viral load decrease. Repeated biopsies at a median of 11.2 months (range, 9.1-12.5 months) after switching to CsA showed that 8 patients (42.1%) were negative for BKV, and 11 patients (58.9%) had a decrease in BKV load ( P < 0.001). There was no statistical difference in the serum creatinine level between the time of diagnosis and 24 months of CsA therapy ( P = 0.963). The graft survival rate was 100%. Only 2 patients (8.3%) suffered from acute rejection.

Conclusions: Switching from tacrolimus to low-dose CsA may be an effective therapy for BKVN.

  • BK virus
  • BK virus nephropathy
  • cyclosporine A
  • tacrolimus
  • conversion of immunosuppression
  • ©2019 The Author(s)

This is an Accepted Manuscript; not the final Version of Record. You are encouraged to use the final Version of Record that, when published, will replace this manuscript and be freely available under a Creative Commons licence.

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The therapeutic effect of switching from tacrolimus to low-dose cyclosporine A in renal transplant recipients with BK virus nephropathy
Xu-Tao Chen, Jun Li, Rong-Hai Deng, Shi-Cong Yang, Yan-Yang Chen, Pei-Song Chen, Ze-Yuan Wang, Yang Huang, Chang-Xi Wang, Gang Huang
Bioscience Reports Feb 2019, BSR20182058; DOI: 10.1042/BSR20182058
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The therapeutic effect of switching from tacrolimus to low-dose cyclosporine A in renal transplant recipients with BK virus nephropathy
Xu-Tao Chen, Jun Li, Rong-Hai Deng, Shi-Cong Yang, Yan-Yang Chen, Pei-Song Chen, Ze-Yuan Wang, Yang Huang, Chang-Xi Wang, Gang Huang
Bioscience Reports Feb 2019, BSR20182058; DOI: 10.1042/BSR20182058

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Keywords

BK virus
BK virus nephropathy
cyclosporine A
tacrolimus
conversion of immunosuppression

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