Background: BK virus nephropathy (BKVN) is a common viral infection that affects up to 10% of renal transplant recipients (RTRs), causing allograft dysfunction and graft loss. The usual management of BKVN involves reduction of immunosuppression and the addition of leflunomide, quinolones and cidofovir, but the rate of graft loss remains high. Fluoroquinolones have been shown in vitro to inhibit BK viral replication by direct inhibition of the BKV-encoded DNA gyrase. We investigated the impact of prophylactic administration of ciprofloxacin for prevention of BK viremia after renal transplantation.
Methods: We retrospectively collected patient and transplant data, as well as incidence of BK viremia, for 113 de novo kidney transplant patients undergoing renal transplantation between January 2010 and January 2012 at St. Vincent Medical Center. Thirty-nine patients received Ciprolaxacin prophylaxis 250 mg daily for 30 days (CP) and 74 patients who received no Cipro prophylaxis (NP). Various clinical data including demographics, renal function and incidence of BKV (BK virus >500 copies per ml by PCR) were retrospectively collected. The categorical data were compared by Chi square test and the t test was used to compare means of continuous variables. The primary endpoint was the rate of occurrence of BKV/BKVN within one year post-transplantation.
Results: Baseline characteristics, transplant demographics, and 1-year incidence of acute rejection were similar between two groups. The incidence of BKV at one year after transplantation was 4 (10.0%) compared with 19 (25.7%) in patients without ciprofloxacin prophylaxis (p=0.045). CP group developed a significant lower peak BK viral load, compared with NP group (median, 10.8 x 10^3 copies/mL vs. 10.4 x 10^4 copies/ml, p=0.044). The peak of BK virus replication appears to be delayed about one month by Cipro prophylaxis (BKV peaked at 5th month in CP group versus 4th month in NP group).
Conclusions: Ciprofloxacin prophylaxis appears to be effective in preventing BK virus replication within one year after transplantation.
To cite this abstract in AMA style:Min D, Vu D, Kawewat B, Poulsen J, Naraghi R, Hutchinson I, Shah T. Effect of Ciprofloxacin Prophylaxis on BK Virus Infection after Renal Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/effect-of-ciprofloxacin-prophylaxis-on-bk-virus-infection-after-renal-transplantation/. Accessed March 31, 2020.
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