Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Oct 24, 2017; 7(5): 269-275
Published online Oct 24, 2017. doi: 10.5500/wjt.v7.i5.269
Graft loss among renal-transplant recipients with early reduction of immunosuppression for BK viremia
Marwan M Azar, Roland Assi, Aziz K Valika, David B Banach, Isaac E Hall, Marie-Louise Landry, Maricar F Malinis
Marwan M Azar, Department of Pathology, Section of Microbiology, Massachusetts General Hospital, Boston, MA 02145, United States
Marwan M Azar, Maricar F Malinis, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, United States
Roland Assi, Maricar F Malinis, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States
Aziz K Valika, Adventist Health Partners, Chicago, IL 60521, United States
David B Banach, Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, CT 06032, United States
Isaac E Hall, Division of Hypertension and Nephrology, University of Utah School of Medicine, Dalt Lake City, UT 84132, United States
Marie-Louise Landry, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
Author contributions: Azar MM and Malinis MF analyzed data; Azar MM drafted manuscript; Assi R, Valika AK, Banach DB, Hall IE, Landry ML and Malinis MF revised and edited manuscript; all authors contributed significantly to this work.
Institutional review board statement: The Yale University Institutional Review Board approved this study and all procedures conducted were in accordance with the Helsinki Declaration of 1975.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marwan M Azar, MD, Microbiology Fellow, Department of Pathology, Section of Microbiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02145, United States. mmazar@mgh.harvard.edu
Telephone: +1-617-6434393 Fax: +1-888-3244639
Received: February 12, 2017
Peer-review started: February 15, 2017
First decision: April 17, 2017
Revised: June 28, 2017
Accepted: August 2, 2017
Article in press: August 2, 2017
Published online: October 24, 2017
Processing time: 252 Days and 8.1 Hours
Core Tip

Core tip: The authors describe results of a retrospective study of 319 renal transplant recipients who underwent reduction of immunosuppression for BK viremia at a BK viral of ≥ 3-log copies/mL. Instituting early reduction of immunosuppression in the absence of adjunctive antivirals was effective in reducing the incidence of graft loss due to Polyoma-virus associated nephropathy (PyVAN) without a reciprocal increase in acute rejection. Our study also emphasizes that efforts to implement universal BK virus polymerase chain reaction assay standards recently developed by the World Health Organization are key in establishing a preventative strategy for PyVAN that is widely applicable and highly effective.