There is no active treatment for post-renal transplantation BK virus nephropathy (BKVN) proved to be effective so far. Leflunomide, intravenous immunoglobulin (IVIG) and ciprofloxacin are still under investigation as active measures for BKVN treatment. To assess the efficacy of active management for BKVN on graft outcome after one year, Renal transplant recipients (RTR) with positive BKV-PCR in urine and blood twice underwent graft biopsy to confirm BKVN. Once BKVN is diagnosed, anti-metabolites (mycophenolate mofetil or azathioprine) were changed to leflunomaide, a course of IVIG and oral ciprofloxacin were given. Serial monitoring of BKV-PCR in urine and blood were carried out. Repeat graft biopsy was done when indicated. Eighteen RTR were reviewed, 72% were males, one RTR received the second renal transplant, deceased donors were 50%, mean HLA mismatches was 3.6, all RTR received induction therapy (61% thymoglobulin and 39% basiliximab) and 60% received antirejection treatment. Maintenance immunosuppression was prednisolone (93%), MMF (93%), Tacrolimus (61%), CsA(33.5%) and sirolimus (5.5%). Baseline mean s.creatinine was 191.6 which increased to 339 umol/l at one year (p 0.026). According to baseline renal function, patients were divided into two groups; 7 RTR in group 1 and 11 RTR in group 2 (mean s.creatinine 150 vs. 218 umol/l). At one year, mean s.creatinine increased to 159 umol/l (p 0.818) for group1 and 454umol/l (p <0.0001) for group2. Three grafts were lost by the end of the study (16.6%), all were in group 2 (p 0.005). In conclusion, Lack of regular screening, late diagnosis and heavy immunosuppression are predisposing factors for development of BKVN. Active treatment for BKVN by leflunomide, IVIG and ciprofloxacin may improve graft outcome at one year if given early before significant deterioration of graft function occurs.
Volume : 6
Issue : 4
Pages : 19
Hamed Alessa Organ Transplantation Center, Ibn Sina hospital, Kuwait, Kuwait