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. 2025 Jan 22;15(1):2872.
doi: 10.1038/s41598-025-86465-2.

The association between serum tacrolimus concentrations and BK viruria in kidney transplant recipients

Napatsorn Kraivisitkul  1 , Kajohnsak Noppakun  2   3 , Chotiwit Sakuludomkan  4   5 , Supavit Jirawattanapong  1 , Siriaran Kwangsukstith  1 , Nahathai Dukaew  4   5 , Naruemon Suyayai  6 , Mingkwan Na Takuathung  4   5 , Nut Koonrungsesomboon  7   8   9
Affiliations

The association between serum tacrolimus concentrations and BK viruria in kidney transplant recipients

Napatsorn Kraivisitkul et al. Sci Rep. .

Abstract

The objective of this study was to examine the association between serum tacrolimus trough levels and the detection of BK viruria in kidney transplant recipients. We conducted a retrospective study and included kidney transplant recipients who underwent BK viruria screening during 2018-2021. Serum tacrolimus trough levels, urine BK viral load, and potential risk factors were collected. Statistical analysis was performed to identify the association between the serum tacrolimus trough levels and the detection of BK virus in urine (defined as positive BK viruria), as well as to determine the cumulative incidence and risk factors for BK viruria. Out of 243 recipients, 76 had positive BK viruria. The average serum tacrolimus trough level was significantly higher among the positive BK viruria group compared to the BK viruria-negative group. High HLA mismatch was identified as a risk factor for BK viruria. Approximately half of the recipients with average serum tacrolimus trough levels exceeding 10 ng/mL would develop BK viruria early. This study found an association between the average serum tacrolimus trough level and the detection of BK viruria. High HLA mismatch and an average serum tacrolimus trough level exceeding 10 ng/mL should be regarded as a risk for BK viruria.

Keywords: BK viruria; BK virus nephropathy; Risk factors; Tacrolimus; Therapeutic drug monitoring.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Research Ethics Committee of the Faculty of Medicine, Chiang Mai University (No.146/2021). Interests to declare: The authors have no relevant financial or non-financial interests to disclose. Informed consent: Patient consent was waived due to the retrospective nature of this study. The Research Ethics Committee of the Faculty of Medicine, Chiang Mai University, granted a waiver of informed consent.

Figures

Fig. 1
Fig. 1
Comparison of average serum tacrolimus trough levels among kidney transplant recipients based on BK virus infection outcomes: BK viruria, BK viremia, and BKVAN, subsequently categorized into positive and negative groups for each outcome.
Fig. 2
Fig. 2
Kaplan–Meier curve depicting the cumulative incidence of BK viruria within 12 months post-transplantation, stratified by three ranges of average serum tacrolimus trough levels (Tacx).
See this image and copyright information in PMC

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