BK Virus–Associated Nephropathy in Sirolimus-Treated Renal Transplant Patients: Incidence, Course, and Clinical Outcomes

Abstract

Patients treated with SRL-based immunosuppression showed an incidence at the lower end of the range described with various other contemporaneous immunosuppressive regimens and with other cohorts not undergoing BK virus polymerase chain reaction surveillance. Exposure to rATG and SPK transplantation represented risk factors for the occurrence of PVAN, which showed a pernicious course despite withdrawal of calcineurin antagonists and/or mycophenolate mofetil.

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

“…Since the majority of patients (7 of 9) that were treated for acute rejection received depleting antibody therapy, these data further implicate a history of depleting antibody use in BKVAN outcomes. Whether depleting antibody therapy predisposes patients to BKVAN is controversial, as some studies have found a correlation between antilymphocyte preparation use and the development of BKVAN (22,25) and others have not (9,26). It is possible that patients who are given depleting antibody therapy, either for induction or acute rejection, are at higher immunological risk and thus may be exposed to higher levels of chronic immunosuppression, which could bias the outcomes in BKVAN.…”

“…The strategy of discontinuation of CNI with maintenance SRL (2 mg/d, goal trough Ͻ8 mg/ml) and low-dose prednisone was applied to the majority of patients in the Withdrawal cohort, with considerable success in preventing graft loss while avoiding acute rejection. This strategy was first reported with success in a case series of 3 subjects (21) but with poorer outcomes when recently reported in a separate cohort of 9 patients (5 of the 9 patients lost graft function at a mean follow-up of 17.5 mo following transition to SRL/prednisone, goal SRL trough levels of 10 Ϯ 3 ng/ml) (22). Our more favorable outcomes may be due to a further reduction in immunosuppression with a lower target SRL trough compared with this series.…”

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

“…Drugs in cause for these events seem to be the combination of tacrolimus, mycophenolate mofetil and monoclonal or polyclonal antibodies Nickeleit et al 1999;Nickeleit et al 2000a;Nickeleit et al 2003;Benavides et al 2007). The organ and the graft type also play a role.…”

BKV-infection in kidney graft dysfunction

“…This drug acts as an anti-proliferative agent and has been suggested as an alternative treatment for viral replication control in established BKV disease. 30,31 Molecular detection of polioviruses has been considered as a gold-standard, and its effi cacy has been confi rmed by a variety of studies. 2,13,24,32 Nowadays, regarding the countless different molecular techniques available for Polyomavirus detection, 16,32 quantitative PCR with viral load defi nition is the most sensitive and specifi c approach.…”