A Single Center Comparison of Various BK Viremia Elimination Protocols
Division of Transplantation, University Of Southern California. Keck Med Center, Los Angeles, CA.
Meeting: 2015 American Transplant Congress
Abstract number: A29
Keywords: Polyma virus
Session Information
Session Name: Poster Session A: BK Virus Infection
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Aim BK infection remains a significant complication post kidney transplantation. Best practices in BK management have evolved over time. The purpose of the study was to compare various therapeutic protocols used in the management of BK infection at our center. Methods: We compared three treatment protocols of : Immunosuppression reduction alone (ISRA) , ISRA with cidofovir infusions (ISRAC) , ISRA with low dose IVIG (ISRAIg). ISRA protocol: Calcineurin inhibitor and MMF reduction (50-75 % reductions or MMF conversion to Arava ) ISRAC protocol :Weekly treatment with low-dose cidofovir (0.5–1.0 mg/kg body weight) for a total of 4 minimum to 10 maximum weeks. ISRAIg protocol : IVIG 100mg /kg x 6 doses spread over 4 months. The protocols were from two different time periods: Period 1 ( BK serum checked when Cr increased by 25 %) vs Period 2 ( serial monthly BK tested from Tx to 1 year with IVig added after persistence of BK viremia despite I/S reduction). Patients were picked randomly from a list of BK positive database and enrolled if serial and multiple BK PCR were available. Serum BK at diagnosis, 6 month, and last f/u BK were used for analysis. Undetectable serum BK at last follow up was used to define BK clearance(BKC) . Results:The number of pts in each group was 9 ISRA, 7 ISRAC, 8 ISRAIg. The mean BK viral loads for ISRA,ISRAC,ISRAIg at Dx and 6 months were 43096(1305-150000), 52133(1047-207600) vs 1340355(2700-3900000),345140( 1700-1200000) vs 249428(7950-739050), 93732(577-320000). The BKC for ISRA,ISRAC,ISRAIg groups was 2/9(22%), 1/7(14%), 5/8 (75%) respectively. Despite stabilization of BK viral loads by all protocols, the highest rates of BKC was in the ISRAIg groups ConclusionsBK infection continues to remain an important issue post transplant. Our study presents a novel low dose IVIG protocol in conjunction with serial monitoring as an effective way of clearing BK viremia. In our experience, adding low dose IVIG after ISRA fails to clear viremia appears to be the best option to mitigate BK viremia. Data is being collected prospectively on this protocol.
To cite this abstract in AMA style:
Qazi Y, Lee K, Duong B, Dhawan R, Shinn L, Aguirre L, Parke C, Wong C, Alexopoulos S, Olson D, Smogorzewski M. A Single Center Comparison of Various BK Viremia Elimination Protocols [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/a-single-center-comparison-of-various-bk-viremia-elimination-protocols/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress