My previous post gave the final result of the study, but not any of the hard numbers that give it credence. I hope to address that here.
The study (conducted over a 1 year interval) showed that by 3 months, the rates of viremia and viruria in both the Tac-arm and the CsA-arm had increased by nearly the same amount, 10% and 14% with CsA having the larger percentage. At 6 months something interesting occurred the two rates diverging and reversing, with the Tac-arm having 16.3% Viremia and CsA having 10.6%. This trend was shown continuing at the 12 month mark (Tac-12.1%, CsA-4.8%).
This therefore shows the significantly increased risk of developing BK nephropathy when given high potency agents. This should not, however, be interpreted to mean that CsA’s benefits automatically outweigh its costs. Weaker immunosuppression runs the higher risk of having the body inflict damage to the graft. What should be taken away from this study is the importance of balance. Finding the balance between the risk of developing BK related issues and the risk of an immune response for each individual person remains the ultimate goal for maximizing kidney graft longevity and thus bettering the life of the patient.
Attached above is a picture showing the graphed trends (%) for BK Viruria (left) and BK Viremia (right) over the one year interval with Cyclosporine being the solid point line and Tacrolimus being hollow.
What specifically is done to find that balance? Is it a thorough analysis of the individual patient and hypothesizing what might be best given the individual's medical history and unique situation?
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