Influence of tacrolimus metabolism rate on BKV infection after kidney transplantation

Gerold Thölking, Christina Schmidt, Raphael Koch, Katharina Schuette-Nuetgen, Dirk Pabst, Heiner Wolters, Iyad Kabar, Anna Hüsing, Hermann Pavenstädt, Stefan Reuter, Barbara Suwelack

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Abstract

Immunosuppression is the major risk factor for BK virus nephropathy (BKVN) after renal transplantation (RTx). As the individual tacrolimus (Tac) metabolism rate correlates with Tac side effects, we hypothesized that Tac metabolism might also influence the BKV infection risk. In this case-control study RTx patients with BK viremia within 4 years after RTx (BKV group) were compared with a BKV negative control group. The Tac metabolism rate expressed as the blood concentration normalized by the daily dose (C/D ratio) was applied to assess the Tac metabolism rate. BK viremia was detected in 86 patients after a median time of 6 (0-36) months after RTx. BKV positive patients showed lower Tac C/D ratios at 1, 3 and 6 months after RTx and were classified as fast Tac metabolizers. 8 of 86 patients with BK viremia had histologically proven BKN and a higher median maximum viral load than BKV patients without BKN (441,000 vs. 18,572 copies/mL). We conclude from our data that fast Tac metabolism (C/D ratio <1.05) is associated with BK viremia after RTx. Calculation of the Tac C/D ratio early after RTx, may assist transplant clinicians to identify patients at risk and to choose the optimal immunosuppressive regimen.

Original languageEnglish (US)
Article number32273
JournalScientific reports
Volume6
DOIs
Publication statusPublished - Aug 30 2016

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Thölking, G., Schmidt, C., Koch, R., Schuette-Nuetgen, K., Pabst, D., Wolters, H., ... Suwelack, B. (2016). Influence of tacrolimus metabolism rate on BKV infection after kidney transplantation. Scientific reports, 6, [32273]. https://doi.org/10.1038/srep32273