Elsevier

Transplantation Proceedings

Volume 51, Issue 9, November 2019, Pages 2936-2938
Transplantation Proceedings

42nd Congress of the Italian Transplantation Society
Renal transplantation
Viremia Negativization After BK Virus Infection in Kidney Transplantation: A National Bicentric Study

https://doi.org/10.1016/j.transproceed.2019.04.091Get rights and content

Highlights

  • BK virus (BKV) infection represents a potentially dreadful complication after kidney transplantation.

  • Early BKV diagnosis and stepwise minimization of immunosuppression are the first-line approaches in patients with BK viremia.

  • In patients with BKV nephropathy, a combination of antiviral drugs should permit viremia clearance.

Abstract

Background

BK virus (BKV) infection represents a potentially dreadful complication after kidney transplantation (KT). When BK viremia is detected, the best therapeutic approach remains not entirely clarified. Critical elements of BK viremia treatment are immunosuppression minimization and introduction of drugs like leflunomide, everolimus, and fluoroquinolones. The study aimed to analyze the results of the BK viremia management in 2 collaborative Italian centers.

Methods

Ten patients undergoing KT in the 2 collaborative Italian centers of Sapienza University of Rome and University of L’Aquila from January 2013 to December 2017 and showing a post-KT diagnosis of BK viremia were retrospectively investigated.

Results

Mean time from KT to BKV positivity was 7 months (range: 1-19 months). At diagnosis, the mean viral load was 683,842 copies/mL (range: 5800-4,052,415 copies/mL), with an average zenith of 2,428,410 copies/mL (range: 6762-18,022,500 copies/mL). In the 5 patients with BKV nephropathy, we observed a switch from antimetabolite to leflunomide (n = 5), a switch from tacrolimus to everolimus (n = 3), or an introduction of fluoroquinolones (n = 3). BKV clearance was achieved in 3 patients.

Conclusions

Early BKV diagnosis and stepwise minimization of immunosuppression remain the first-line approach in patients with BK viremia. In the presence of BKV nephropathy, a combination of antiviral drugs like leflunomide and fluoroquinolones/everolimus should favor viremia clearance.

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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The first 2 authors contributed equally to this work.

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