Preemptive Intervention Strategy Prevents Polyoma Virus Induced End-Organ Disease in Treatment-Naïve Renal Transplant Patients.

Abstract

Introduction: Polyoma Virus induced End-Organ Disease is an Achilles heel in transplant population. Liverpool Polyoma Virus Screening protocol suggests intervention after observing the increasing viral titres > 10000 gm/Eq copies. We presented our data last year in American Transplant Congress showing that polyoma virus screening protocol helps in reducing the incidence of End-Organ Disease (EOD). Still 4-5% patients developed EOD and 1-2% patients ended up with graft loss despite treatment. This prompted to start intervention pre-emptively. Aim: To assess if pre-emptive treatment introduced at the first positive viral titre prevents progression of disease in Treatment-Naïve renal transplant population. Methods: 102 consecutive renal transplant patients were screened as per Liverpool Polyoma Virus Screening protocol. Mycophenolate Mofetil was stopped and FK506 doses were reduced at the first positive Polyoma Virus PCR. The FK 506 plasma levels were subsequently aimed between 4-6 ng/ml. Renal function pre and post reduction in immunosuppression, median Plasma FK 506 levels and number of FK 506 dose changes were statistically analyzed by MedCalc 18.1 Results: 11/102 patients developed polyoma viremia and with reduction of immunosuppression alone, all had reduction in Polyoma viral load. There was no incidence of Polyoma virus induced EOD. None of the patients developed any episode of acute rejection. The Median FK 506 level and median creatinine level pre polyoma viremia were 8.4 ± 1.5 ng/ml and 210 ± 18 μmol/L respectively. Median FK 506 dose change required to reduce viral titers were 2.0 ± 0.4. The Median FK 506 level and median creatinine level posts polyoma viremia were 4.8 ± 0.6 ng/ml and 128 ± 14 μmol/L respectively. Number of FK 506 dose changes had a statistically significant correlation with Polyoma viral titers (p <0.001). Conclusion: The initial date suggests that pre-emptive intervention strategy of reducing immunosuppression helps in reducing the Polyoma Virus titres thus reducing the EOD eventually. We aim to continue the current practice in order to augment our evidence with bigger sample size.