Background: Following the death of a renal transplant recipient (RTR) in 2003 following BK Virus associated nephropathy (BKVAN) and acute rejection, our centre adopted protocols for early detection and intervention in BK viremia and BKVAN. This study reports our experience (from 1 January 2006 – 30 June 2015) with those protocols.

Methods: New RTR's were screened regularly for BK viremia and urine cytology for decoy cells. Those detected to have BK viremia or decoy cells had transplant biopsies. Protocol biopsies were also performed on all RTR's at 3 months. Those treated for BKVAN were scheduled to be re-biopsied after each course of treatment.

Treatment protocol for BKVIRA involved replacement of Mycophenolate with Leflunomide; halving of Tacrolimus dose; and reduction in corticosteroid. Treatment protocol for BKVAN required addition of Cidofovir (0.25-0.50 mg/kg IVI fortnightly x4 doses). If the follow-up biopsy showed persistent BKVAN then a second course of Cidofovir was given, together with IVIg.

If the index biopsy was deemed to show likely acute rejection, treatment with pulsed Methylprednisolone or Thymoglobulin/PLEX/IVIG was given prior to the BK protocol commencement.

Results: BKVIRA was detected in 55/264 (20.8%) RTR's. 53/264 (20.1%) had decoy celluria. 23/264 had biopsy proven BKVAN. 12/23 patients required a single course of Cidofovir; 7/23 patientscompleted a second course with IVIG; 4 patients had an aborted course because of SAE's (neutropenia = 4, AKI=1). Of 23/55 (42%) RTR's who developed viremia most patients cleared their viremia below cut-off levels of the test, or remained just above cut off. Mean creatinine and GFR at time of the index biopsy and 6 months later had improved in 14/23 (60.8%), was unchanged in 4/23 (17.3%) and had deteriorated in 5/23 (21.7%) of patients. No grafts were deemed to be lost from BKVAN in this period.There were 2 grafts lost from chronic rejection however both had cleared the virus prior. There were 2 deaths in the patient group, both deemed unrelated to BKV.

Conclusion: Biopsy based, early intervention for BK viremia and BKVAN results in clearance of the virus and stabilisation of graft function in the majority of affected RTR's.

CITATION INFORMATION: Jones S, Waller S, Lai K, Hibbard A, Trevillian P, Heer M. Results of a Biopsy Based, Early Intervention Treatment Protocols for BK Viraemia and BK Virus Associated Nephropathy. Am J Transplant. 2016;16 (suppl 3).

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