The risk of polyomavirus-associated graft nephropathy is increased by a combined suppression of CD8 and CD4 cell-dependent immune effects.
Renner FC, Dietrich H, et al.Transplantation Proceedings 2013;45(4): 1608-1610.
Aims
To investigate the impact of three immunosuppressive regimens on intracellular cytokine response patterns of T and B lymphocytes in predicting the risk of BK-Virus reactivation, and if the effects could be detected prior to BK viraemia.
Interventions
Patients received cyclosporine and mycophenolate mofetil (MMF) versus tacrolimus (Tac) and MMF versus, Tac/MMF with conversion to everolimus.
Participants
105 renal transplant recipients.
Outcomes
The outcomes included the incidence of BK viremia and polyomavirus-associated graft nephropathy (PAN) within two years after transplantation, BKV serum and urine concentrations, intracellular T- and B- cell cytokine responses after stimulation with with phorbol myristate acetate/ionomycin and lipopolysaccharide.
Follow-up
2 years.
CET Conclusions
Patients randomised to receive Tac+MMF were more likely to develop BK-Viraemia than patients randomised to cyclosporine+MMF or Tac+MMF with everolimus conversion. There was no difference seen in the rate of BK-Virus nephropathy between the groups. IL-2, IL-4 and IFN-γ responses of CD-4+ cells, as well as B-Cell activity, did not differ between patients with or without BK-Viraemia. It is not clear when conversion to Everolimus occurred, or what serum levels of immune suppression were targeted. It is not clear if live or deceased donors were included or if induction antibodies were used.
Data analysis
Per protocol analysis
Trial registration
Not reported.