system
Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, METHODS, RESULTS. Meshes: BK Virus, Female, Graft Rejection, Graft Survival, HLA Antigens, Humans, Immunosuppression, Immunosuppressive Agents, JC Virus, Kidney Diseases, Kidney Transplantation, Male, Middle Aged, Polyomavirus Infections, Retrospective Studies, Risk Factors, Transplant Recipients, Treatment Outcome, Tumor Virus Infections, Viral Load, Viremia.
user
Does preemptive reduction of immunosuppression upon high urinary polyomavirus loads improve patient survival without affecting kidney graft function? Context: Polyomavirus (PV) is a major cause of kidney graft disease. Monitoring by polymerase chain reaction (PCR) on blood is currently recommended. In order to avoid irreversible lesions, we investigated the clinical impact of preemptive reduction of immunosuppression (IS) in kidney transplant recipients (KTR) upon detection of high urinary PV (Upv) load, including BK virus and JC virus. From 2000 to 2011, in our single center, 789 consecutive KTR were distributed into 4 groups, according to the maximal Upv levels (by PCR) during the first year and the therapeutic option: (A) Upv <10 The preemptive reduction of IS (group Ca) increased patient survival as compared with all other groups (P<.05), did not modify graft function, and increased graft survival vs group A (risk ratio: 5.7, confidence interval: 1.8-18.1, P=.003). Differences for risk factors are as follows (groups Ca vs A): incidence of human leukocyte antigen (HLA) immunization (>5% panel reactive antibodies): 3% vs 8% (P=.05), number of HLA mismatches: 2.7 vs 2.5 (P=.049), and incidence of acute rejection: 9.8% vs 24.2% (P=.005). PV-associated nephropathy occurred only in group Ca (2% of total grafts) without effect on patient or graft outcome.
assistant
The reduction of IS in patients with high Upv loads is beneficial for patient survival and does not affect graft survival or graft function. Final Decision: yes