INTRODUCTION:

BK viremia (BKV) and BK virus nephropathy (BKVN) is recognized as an emerging problem in renal transplant recipients. Only reduction of immunosuppressants had shown efficacy while other interventions such as flouroquinolones, leflunamide, cidofovir, brincidofovir, sirolimus and IVIG did not in the treatment of BKVN in randomized clinical trials. The aim of this study is to describe the treatment methods utilized at University of Kentucky transplant center to treat BKV and BKVN in Renal transplant patients.

MATERIALS/METHODS:

We conducted a retrospective study of all patients with BKV (> 10,000 copies/ml) at the transplant center during the 8 years period (2009-2017). We identified 119 patients with BKV. We analyzed the induction, maintenance immunosuppressive therapies and treatment modalities utilized by the transplant center. We also studied the change in the calcineurin inhibitors levels during the course of the BKV treatment.

RESULTS:

Of the 119 patients with BKV, 72% were induced with thymoglobulin. Other induction agents used included basiliximab (8.4%), alemtuzumab (14.3%), and alefacept (2.5%). No intervention was done for 28% of patients mainly because of spontaneous decay of BKV or absence of biopsy evidence of BKVN. Of those treated (72%), mycophenolate was reduced in 36.0% and stopped in 64.0%. Tacrolimus dosage was reduced from an average of 7.3 mg/day to 5.3 mg/day over the course of treatment. The median trough tacrolimus levels decreased from 7.5 ng/dL to 6.7 ng/dL. Ciprofloxacin was administered in 53.5% of patients, while 29% were treated with leflunomide and 11.6% were treated with IVIG. No patients were treated with cidofovir. Fifty-six percent were treated with more than one agent.

CONCLUSSION:

Reduction of immunosuppression was the most common intervention in patients with BKV. Fluoroquinolones, leflunomide and IVIG were the most commonly used intervention after the reduction of immunosuppression. BKV spontaneous decayed in a significant percentage of patients.

CITATION INFORMATION: Karim A., Hines A., Wang K., Saleh S., Suleiman B., Hassan W., Maibam A., Yaseen M., Castellanos A., Cornea V., Mei X., Gedaly R., Waid T., El-Husseini A. Treatment of BK Viremia: Single-Center Experience Am J Transplant. 2017;17 (suppl 3).

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