42nd Congress of the Italian Transplantation SocietyRenal transplantationViremia Negativization After BK Virus Infection in Kidney Transplantation: A National Bicentric Study
Section snippets
Materials and Methods
A retrospective analysis was carried out on 318 patients undergoing a KT in the 2 collaborative Italian centers of Sapienza University of Rome and University of L’Aquila from January 2013 to December 2017. We started the present study from 2013 because all the patients with a BKV diagnosis before this specific period were managed only with an immunosuppression reduction approach, without any specific drug used with a curative intent against the virus.
In accordance with the Kidney Disease:
Results
Ten (3.1%) patients showed BK viremia. Demographic and BKV characteristics are shown in Table 1. Nine patients were men, with a mean age at transplant of 49 ± 10.7 years. One living donation and retransplant were observed. Five patients had 4 HLA mismatches, 3 had 3 mismatches, and 2 had 5 mismatches. In 3 patients, induction with antithymocyte globulin was performed. In all the patients, immunosuppression maintenance was done using tacrolimus, mycophenolate mofetil, and prednisone. Two
Discussion
BKV infection represents a challenge in the KT setting. Several donor- and recipient-related features have been identified as risk factors for the BKV activation, like the immunosuppressive regimens, the type of donor (deceased vs living), the recipient's male sex, the history of re-KT, the recipient's age, the use of ureteral stents, the delayed graft function, and the acute rejection episodes [4]. BKV should be carefully managed, mainly because of the risk of its evolution to BKVN [1], [5].
Conclusion
Our study reinforces the concept that early diagnosis with monitoring reduces the damage caused by BKV and its evolution in BKVN. A stepwise minimization of immunosuppressive therapy remains the first-line approach in patients with low-to-moderate BK viremia. In patients with BKVN, a combination of antiviral drugs like leflunomide + fluoroquinolones/everolimus seems to be useful in favoring the viremia clearance and in avoiding graft loss. Further more extensive studies are necessary with the
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Cited by (0)
The first 2 authors contributed equally to this work.