BK-virus and the impact of pre-emptive immunosuppression reduction: 5-year results

Am J Transplant. 2010 Feb;10(2):407-15. doi: 10.1111/j.1600-6143.2009.02952.x. Epub 2010 Jan 5.


A 1-year, single-center, randomized trial demonstrated that the calcineurin inhibitor or adjuvant immunosuppression, independently, does not affect BK-viruria or viremia and that monitoring and pre-emptive withdrawal of immunosuppression was associated with resolution of BK-viremia and absence of clinical BK-nephropathy without acute rejection or graft loss. A retrospective 5-year review of this trial was conducted. In cases of BK viremia, the antimetabolite was withdrawn and for sustained viremia, the calcineurin inhibitor was minimized. Five-year follow-up was available on 97% of patients. Overall 5-year patient survival was 91% and graft survival was 84%. There were no differences in patient-survival by immunosuppressive regimen or presence of BK-viremia. Immunosuppression and viremia did not influence graft survival. Acute rejection occurred in 12% by 5-years after transplant, was less common with tacrolimus versus cyclosporine (9% vs. 18%; p = 0.082), and was lowest with the tacrolimus-azathioprine regimen (5%, p = 0.127). Tacrolimus was associated with better renal function at 5-years (eGFR 63 FK vs. 52 CsA mL/min, p = 0.001). Minimization of immunosuppression upon detection of BK-viremia was associated with excellent graft survival at 5-years, low rejection rates and excellent renal function. It is a safe, short and long-term strategy that resulted in freedom from clinically evident BK-virus nephropathy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Azathioprine / therapeutic use
  • BK Virus / drug effects*
  • Cyclosporine / therapeutic use
  • Graft Survival / drug effects
  • Humans
  • Immunosuppression / methods*
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Diseases
  • Kidney Function Tests
  • Tacrolimus / therapeutic use
  • Viremia


  • Immunosuppressive Agents
  • Cyclosporine
  • Azathioprine
  • Tacrolimus