Aggressive Immunosuppression Minimization Reduces Graft Loss Following Diagnosis of BK Virus-Associated Nephropathy

Abstract

Results: Of 910 kidney transplants, 35 (3.8%) cases of BKVAN were diagnosed at a median of 15 months after transplant (range, 5.5 to 90 months after transplant), 16 (46%) of which progressed to graft failure at a median of 11 months (range, 2 to 36 months) after diagnosis. Depleting antibody induction was a significant risk factor for graft loss on univariate analysis, whereas early drug withdrawal (<1 mo following diagnosis) protected against graft loss. On multivariate analysis, these findings were independent predictors of graft outcomes. Additionally, when patients were comanaged by referring nephrologists and the transplant center before the diagnosis of BKVAN, the risk of graft loss was 11-fold higher (P ‫؍‬ 0.03) than if patients were managed solely by the transplant center.Conclusions: Increased awareness and early diagnosis of BKVAN, with aggressive tapering of immunosuppression once established, is critical to preserve kidney graft function. Early drug withdrawal to low-dose two-drug therapy maintenance may be preferable to a general reduction of agents.

Reducing Immunosuppression Preserves Allograft Function in Presumptive and Definitive Polyomavirus-Associated Nephropathy

“…All treated with steroid pulses. 2 Borderline tubulitis (n = 3; one treated with steroid pulses), tubulitis Ia (n = 2; one treated with steroid pulses), tubulitis Ib (n = 1; treated with steroid pulses), antibody-mediated rejection in a patient with pretransplant HLA-DSA (n = 1; treated with steroid pulses, IvIg, and rituximab).…”

“…Before noninvasive diagnostic tests were routinely used, PyVAN was mostly diagnosed late in an advanced stage with irreversible functional damage, leading to allograft loss in as many as 90% of cases (1,2). Surveillance biopsies have enabled an earlier diagnosis with improved outcome for a significant number of patients (3).…”

Leflunomide an Immunosuppressive Drug for Antiviral Purpose in Treatment for BK Virus-Associated Nephropathy After Kidney Transplantation

“…The regimen modifications and results are presented in table 1 and figure 1. The Withdrawal cohort had significantly better graft survival at 1 year compared with the Reduction cohort (1-year graft survival 87.8% versus 56.2%, P = 0.03) (Weiss et al 2008 …”

Topics in Transplantation Medicine for General Nephrologists

“…Response to decrease in immunosuppression is monitored by checking plasma BK PCR at regular intervals, usually every 2 weeks. Renal function needs to be monitored closely as there is always concern for precipitating rejection with decrease in immunosuppression (32).…”