{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:03:25Z","timestamp":1779350605692,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T00:00:00Z","timestamp":1716940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007623","name":"School of Medicine, Emory University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007623","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>BK polyomavirus (BKV) DNAemia is a challenging infectious complication after kidney transplant (KT). Reduction of immunosuppression is the mainstay of management, and tacrolimus is often the first immunosuppressive medication adjusted upon the diagnosis of BKV DNAemia. This study aimed to evaluate the impact of a new institutional protocol with lower target tacrolimus levels on BKV DNAemia, allograft rejection, and de novo donor\u2010specific antibodies (dnDSA) among pediatric KT recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective chart review of all KT episodes between January 2013 and December 2018. The new protocol with lower target tacrolimus levels was implemented in March 2015. One hundred twenty\u2010seven patients were included in primary analysis. All patients received induction with basiliximab and methylprednisolone and were maintained on a steroid\u2010based immunosuppressive regimen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the post\u2010intervention cohort, cumulative incidence of BKV DNAemia at 100\u2009days (13.4% vs. 17.8%, <jats:italic>p<\/jats:italic>\u2009=\u2009.605) and 18\u2009months post\u2010KT (34.1% vs. 26.7%, <jats:italic>p<\/jats:italic>\u2009=\u2009.504) was not significantly different from the pre\u2010intervention cohort. Biopsy\u2010proven rejection rate did not change. However, we observed a trend toward earlier development of dnDSA in the post\u2010intervention cohort using the Kaplan\u2013Meier survival analysis (log\u2010rank <jats:italic>p<\/jats:italic>\u2009=\u2009.06). Younger recipient age at the time of transplant was found to slightly increase the risk of BKV DNAemia (OR: 1.09, 95% CI [1.01, 1.16], <jats:italic>p<\/jats:italic>\u2009=\u2009.024). There was an association between BKV DNAemia and biopsy\u2010proven rejection of any type (<jats:sub>adjusted<\/jats:sub>OR: 2.77, 95% CI [1.26, 6.23], <jats:italic>p<\/jats:italic>\u2009=\u2009.012), especially acute T\u2010cell\u2010mediated rejection grade 1A and above (<jats:sub>adjusted<\/jats:sub>OR: 2.95, 95% CI [1.06, 8.30], <jats:italic>p<\/jats:italic>\u2009=\u2009.037), after adjusted for recipient age at the time of transplant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Targeting lower tacrolimus levels did not decrease the incidence of BKV DNAemia within 100\u2009days or 18\u2009months post\u2010KT, nor did it increase the risk of biopsy\u2010proven rejection among pediatric KT recipients in our center. However, there was a trend toward earlier development of dnDSA, which may portend worse long\u2010term graft outcome post\u2010KT. Our findings highlight the need for individualized immunosuppressive regimens based on immunologic and infectious risk factors and the importance of implementing innovative biomarkers to guide therapy and improve outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14791","type":"journal-article","created":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T11:37:24Z","timestamp":1716982644000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["BK polyomavirus DNAemia, allograft rejection, and de novo donor\u2010specific antibodies after lowering target tacrolimus levels in pediatric kidney transplant recipients"],"prefix":"10.1111","volume":"28","author":[{"given":"Hou\u2010Xuan","family":"Huang","sequence":"first","affiliation":[{"name":"Emory University School of Medicine  Atlanta Georgia USA"},{"name":"Children's Healthcare of Atlanta  Atlanta Georgia 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Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rochelle","family":"Liverman","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8631-0020","authenticated-orcid":false,"given":"Inci","family":"Yildirim","sequence":"additional","affiliation":[{"name":"Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rouba","family":"Garro","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine  Atlanta Georgia USA"},{"name":"Children's Healthcare of Atlanta  Atlanta Georgia 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