Risk Prediction and Management of BKPyV-DNAemia in Kidney Transplant Recipients: A Multicenter Analysis of Immunosuppressive Strategies
BK polyomavirus (BKPyV) DNAemia remains a major complication in kidney transplantation (KT), requiring nuanced adjustments to immunosuppressive regimens to control viral replication while minimizing rejection risk. This retrospective multicenter cohort study included 8,027 KT recipients, of whom 1,1...
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Frontiers Media S.A.
2025-07-01
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| Series: | Transplant International |
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| Online Access: | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14738/full |
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| author | Jin-Myung Kim Hye Eun Kwon Ahram Han Youngmin Ko Sung Shin Young Hoon Kim Kyo Won Lee Jae Berm Park Hyunwook Kwon Sangil Min |
| author_facet | Jin-Myung Kim Hye Eun Kwon Ahram Han Youngmin Ko Sung Shin Young Hoon Kim Kyo Won Lee Jae Berm Park Hyunwook Kwon Sangil Min |
| author_sort | Jin-Myung Kim |
| collection | DOAJ |
| description | BK polyomavirus (BKPyV) DNAemia remains a major complication in kidney transplantation (KT), requiring nuanced adjustments to immunosuppressive regimens to control viral replication while minimizing rejection risk. This retrospective multicenter cohort study included 8,027 KT recipients, of whom 1,102 developed BKPyV-DNAemia within the first year. Among them, 927 patients with complete therapeutic drug monitoring (TDM) data were categorized into three groups based on post- BKPyV-DNAemia immunosuppressive strategies: mycophenolic acid (MPA) control, sirolimus, and leflunomide. Multivariate logistic regression and Cox analyses identified risk factors for BKPyV-DNAemia treatment failure, acute rejection, and graft loss. Tacrolimus trough levels below 5 ng/mL and complete withdrawal of calcineurin inhibitors (CNIs) significantly increased rejection risk (OR = 2.65, P = 0.033). Maintaining tacrolimus levels between 5 and 7 ng/mL was associated with optimal viral control and lower rejection rates. Leflunomide substitution reduced BKPyV burden but increased rejection risk (OR = 2.14, P < 0.001). Sirolimus-based regimens with CNI withdrawal led to the highest rejection risk (OR = 6.00, P = 0.044) and a trend toward increased graft failure (HR = 4.37, P = 0.07). A tacrolimus target of ≥5 ng/mL emerged as optimal for balancing BKPyV-DNAemia suppression and long-term graft survival. While leflunomide is effective for viral control, its immunological risks warrant careful patient selection and monitoring. |
| format | Article |
| id | doaj-art-c7ea46a50f1445ad8986c6e211f794f6 |
| institution | Kabale University |
| issn | 1432-2277 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Transplant International |
| spelling | doaj-art-c7ea46a50f1445ad8986c6e211f794f62025-08-20T03:51:48ZengFrontiers Media S.A.Transplant International1432-22772025-07-013810.3389/ti.2025.1473814738Risk Prediction and Management of BKPyV-DNAemia in Kidney Transplant Recipients: A Multicenter Analysis of Immunosuppressive StrategiesJin-Myung Kim0Hye Eun Kwon1Ahram Han2Youngmin Ko3Sung Shin4Young Hoon Kim5Kyo Won Lee6Jae Berm Park7Hyunwook Kwon8Sangil Min9Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDivision of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDivision of Transplantation and Vascular Surgery, Department of Surgery, Seoul National University Hospital, Seoul, Republic of KoreaDivision of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDivision of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDivision of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaDivision of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaDivision of Transplantation and Vascular Surgery, Department of Surgery, Seoul National University Hospital, Seoul, Republic of KoreaBK polyomavirus (BKPyV) DNAemia remains a major complication in kidney transplantation (KT), requiring nuanced adjustments to immunosuppressive regimens to control viral replication while minimizing rejection risk. This retrospective multicenter cohort study included 8,027 KT recipients, of whom 1,102 developed BKPyV-DNAemia within the first year. Among them, 927 patients with complete therapeutic drug monitoring (TDM) data were categorized into three groups based on post- BKPyV-DNAemia immunosuppressive strategies: mycophenolic acid (MPA) control, sirolimus, and leflunomide. Multivariate logistic regression and Cox analyses identified risk factors for BKPyV-DNAemia treatment failure, acute rejection, and graft loss. Tacrolimus trough levels below 5 ng/mL and complete withdrawal of calcineurin inhibitors (CNIs) significantly increased rejection risk (OR = 2.65, P = 0.033). Maintaining tacrolimus levels between 5 and 7 ng/mL was associated with optimal viral control and lower rejection rates. Leflunomide substitution reduced BKPyV burden but increased rejection risk (OR = 2.14, P < 0.001). Sirolimus-based regimens with CNI withdrawal led to the highest rejection risk (OR = 6.00, P = 0.044) and a trend toward increased graft failure (HR = 4.37, P = 0.07). A tacrolimus target of ≥5 ng/mL emerged as optimal for balancing BKPyV-DNAemia suppression and long-term graft survival. While leflunomide is effective for viral control, its immunological risks warrant careful patient selection and monitoring.https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14738/fullkidney transplantationBk virusimmunosuppressive therapycalcineurin inhibitortacrolimus trough level |
| spellingShingle | Jin-Myung Kim Hye Eun Kwon Ahram Han Youngmin Ko Sung Shin Young Hoon Kim Kyo Won Lee Jae Berm Park Hyunwook Kwon Sangil Min Risk Prediction and Management of BKPyV-DNAemia in Kidney Transplant Recipients: A Multicenter Analysis of Immunosuppressive Strategies Transplant International kidney transplantation Bk virus immunosuppressive therapy calcineurin inhibitor tacrolimus trough level |
| title | Risk Prediction and Management of BKPyV-DNAemia in Kidney Transplant Recipients: A Multicenter Analysis of Immunosuppressive Strategies |
| title_full | Risk Prediction and Management of BKPyV-DNAemia in Kidney Transplant Recipients: A Multicenter Analysis of Immunosuppressive Strategies |
| title_fullStr | Risk Prediction and Management of BKPyV-DNAemia in Kidney Transplant Recipients: A Multicenter Analysis of Immunosuppressive Strategies |
| title_full_unstemmed | Risk Prediction and Management of BKPyV-DNAemia in Kidney Transplant Recipients: A Multicenter Analysis of Immunosuppressive Strategies |
| title_short | Risk Prediction and Management of BKPyV-DNAemia in Kidney Transplant Recipients: A Multicenter Analysis of Immunosuppressive Strategies |
| title_sort | risk prediction and management of bkpyv dnaemia in kidney transplant recipients a multicenter analysis of immunosuppressive strategies |
| topic | kidney transplantation Bk virus immunosuppressive therapy calcineurin inhibitor tacrolimus trough level |
| url | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14738/full |
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