Conversion to mTOR-Inhibitors Plus IV Immunoglobulins in Kidney-Transplant Recipients with BKV Infection: A Retrospective Comparative Study
BK virus-associated nephropathy (PvAN) increases the risk of graft failure justifying treatment. Conversion to mammalian target of rapamycin inhibitors (mTORi) and Human polyclonal immunoglobulins (IVIg) could prevent the risk of PvAN. Our retrospective study assessed the efficacy of mTORi associate...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-12-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/11/24/7292 |
| _version_ | 1797457044534460416 |
|---|---|
| author | Carla Vela Thomas Jouve Eloi Chevallier Farida Imerzoukene Raphaële Germi Marion Le Marechal Aurélie Truffot Gaëlle Fiard Bénédicte Janbon Diane Giovannini Paolo Malvezzi Lionel Rostaing Johan Noble |
| author_facet | Carla Vela Thomas Jouve Eloi Chevallier Farida Imerzoukene Raphaële Germi Marion Le Marechal Aurélie Truffot Gaëlle Fiard Bénédicte Janbon Diane Giovannini Paolo Malvezzi Lionel Rostaing Johan Noble |
| author_sort | Carla Vela |
| collection | DOAJ |
| description | BK virus-associated nephropathy (PvAN) increases the risk of graft failure justifying treatment. Conversion to mammalian target of rapamycin inhibitors (mTORi) and Human polyclonal immunoglobulins (IVIg) could prevent the risk of PvAN. Our retrospective study assessed the efficacy of mTORi associated with IVIg therapy (mTORi±IVIg group) versus standard immunosuppression reduction to clear BKV DNAemia. Among forty-three kidney-transplanted patients with positive BKV DNAemia, we included twenty-six patients in the mTORi±IVIg group and reduced immunosuppression therapy for seventeen patients. We focused on BKV DNAemia clearance on the first-year. Renal function, rejection rate, evolution to PvAN, and complications of immunosuppression were assessed. BKV DNAemia decreased faster and significantly in the control group as compared to the mTORi±IVIg group (<i>p</i> < 0.001). Viral clearance was significantly higher in the control group compared to the mTORi±IVIg group (88% vs. 58%; <i>p</i> = 0.033). Death-censored graft loss, rejection rates and kidney-graft function at 12 months did not significantly differ. Multivariate analyses significantly associated BKV DNAemia clearance with reducing immunosuppression (OR = 0.11 (0.06–0.9), <i>p</i> = 0.045), female kidney donor (OR = 0.10 (0.01–0.59/)], <i>p</i> = 0.018) and time to first DNAemia, (OR = 0.88 (0.76–0.96), <i>p</i> = 0.019). In our study, the standard treatment for BKV DNAemia had better outcomes than an mTORi±IVIg conversion. |
| first_indexed | 2024-03-09T16:16:32Z |
| format | Article |
| id | doaj.art-1eedac1cd56548e08a291d9b1d22f08e |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T16:16:32Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1eedac1cd56548e08a291d9b1d22f08e2023-11-24T15:43:02ZengMDPI AGJournal of Clinical Medicine2077-03832022-12-011124729210.3390/jcm11247292Conversion to mTOR-Inhibitors Plus IV Immunoglobulins in Kidney-Transplant Recipients with BKV Infection: A Retrospective Comparative StudyCarla Vela0Thomas Jouve1Eloi Chevallier2Farida Imerzoukene3Raphaële Germi4Marion Le Marechal5Aurélie Truffot6Gaëlle Fiard7Bénédicte Janbon8Diane Giovannini9Paolo Malvezzi10Lionel Rostaing11Johan Noble12Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Universitary Hospital Grenoble, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Universitary Hospital Grenoble, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Universitary Hospital Grenoble, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Universitary Hospital Grenoble, 38000 Grenoble, FranceMedicine Faculty, University of Grenoble Alpes, 38000 Grenoble, FranceMedicine Faculty, University of Grenoble Alpes, 38000 Grenoble, FranceMedicine Faculty, University of Grenoble Alpes, 38000 Grenoble, FranceMedicine Faculty, University of Grenoble Alpes, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Universitary Hospital Grenoble, 38000 Grenoble, FrancePathology Department, Universitary Hospital Grenoble, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Universitary Hospital Grenoble, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Universitary Hospital Grenoble, 38000 Grenoble, FranceNephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Universitary Hospital Grenoble, 38000 Grenoble, FranceBK virus-associated nephropathy (PvAN) increases the risk of graft failure justifying treatment. Conversion to mammalian target of rapamycin inhibitors (mTORi) and Human polyclonal immunoglobulins (IVIg) could prevent the risk of PvAN. Our retrospective study assessed the efficacy of mTORi associated with IVIg therapy (mTORi±IVIg group) versus standard immunosuppression reduction to clear BKV DNAemia. Among forty-three kidney-transplanted patients with positive BKV DNAemia, we included twenty-six patients in the mTORi±IVIg group and reduced immunosuppression therapy for seventeen patients. We focused on BKV DNAemia clearance on the first-year. Renal function, rejection rate, evolution to PvAN, and complications of immunosuppression were assessed. BKV DNAemia decreased faster and significantly in the control group as compared to the mTORi±IVIg group (<i>p</i> < 0.001). Viral clearance was significantly higher in the control group compared to the mTORi±IVIg group (88% vs. 58%; <i>p</i> = 0.033). Death-censored graft loss, rejection rates and kidney-graft function at 12 months did not significantly differ. Multivariate analyses significantly associated BKV DNAemia clearance with reducing immunosuppression (OR = 0.11 (0.06–0.9), <i>p</i> = 0.045), female kidney donor (OR = 0.10 (0.01–0.59/)], <i>p</i> = 0.018) and time to first DNAemia, (OR = 0.88 (0.76–0.96), <i>p</i> = 0.019). In our study, the standard treatment for BKV DNAemia had better outcomes than an mTORi±IVIg conversion.https://www.mdpi.com/2077-0383/11/24/7292BK virus infectionmTOR inhibitorsrenal transplantation |
| spellingShingle | Carla Vela Thomas Jouve Eloi Chevallier Farida Imerzoukene Raphaële Germi Marion Le Marechal Aurélie Truffot Gaëlle Fiard Bénédicte Janbon Diane Giovannini Paolo Malvezzi Lionel Rostaing Johan Noble Conversion to mTOR-Inhibitors Plus IV Immunoglobulins in Kidney-Transplant Recipients with BKV Infection: A Retrospective Comparative Study Journal of Clinical Medicine BK virus infection mTOR inhibitors renal transplantation |
| title | Conversion to mTOR-Inhibitors Plus IV Immunoglobulins in Kidney-Transplant Recipients with BKV Infection: A Retrospective Comparative Study |
| title_full | Conversion to mTOR-Inhibitors Plus IV Immunoglobulins in Kidney-Transplant Recipients with BKV Infection: A Retrospective Comparative Study |
| title_fullStr | Conversion to mTOR-Inhibitors Plus IV Immunoglobulins in Kidney-Transplant Recipients with BKV Infection: A Retrospective Comparative Study |
| title_full_unstemmed | Conversion to mTOR-Inhibitors Plus IV Immunoglobulins in Kidney-Transplant Recipients with BKV Infection: A Retrospective Comparative Study |
| title_short | Conversion to mTOR-Inhibitors Plus IV Immunoglobulins in Kidney-Transplant Recipients with BKV Infection: A Retrospective Comparative Study |
| title_sort | conversion to mtor inhibitors plus iv immunoglobulins in kidney transplant recipients with bkv infection a retrospective comparative study |
| topic | BK virus infection mTOR inhibitors renal transplantation |
| url | https://www.mdpi.com/2077-0383/11/24/7292 |
| work_keys_str_mv | AT carlavela conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT thomasjouve conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT eloichevallier conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT faridaimerzoukene conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT raphaelegermi conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT marionlemarechal conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT aurelietruffot conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT gaellefiard conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT benedictejanbon conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT dianegiovannini conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT paolomalvezzi conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT lionelrostaing conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy AT johannoble conversiontomtorinhibitorsplusivimmunoglobulinsinkidneytransplantrecipientswithbkvinfectionaretrospectivecomparativestudy |