Effectiveness and Tolerability of Cidofovir for the Management of BK Viremia in Kidney Transplant Recipients
1NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY, 2Columbia Irving University Medical Center, Department of Transplant Surgery, New York, NY
Meeting: 2020 American Transplant Congress
Abstract number: C-207
Keywords: Graft failure, Infection, Kidney transplantation, Polyma virus
Session Information
Session Name: Poster Session C: Kidney: Polyoma
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: BK viremia (BKV) is a common complication after kidney transplantation (KT) that often leads to graft dysfunction and loss. Without consensus management guidelines and large randomized trials to assess BKV management, the efficacy of various strategies remain unclear. Our study aims to evaluate effectiveness and tolerability associated with the use of cidofovir for BKV treatment in a large cohort of KT recipients.
*Methods: This single-center retrospective cohort study of all KT recipients who received cidofovir for BKV between Jan 2015 and July 2019 was approved by the IRB. The primary outcome was incidence of BKV clearance within 3 months of cidofovir initiation. Descriptive statistics were performed to assess characteristics of the cohort.
*Results: During the period of study, 27 KT recipients with BKV received cidofovir. Patient demographics and BKV characteristics are summarized in Table 1. Changes in immunosuppression before and after BKV diagnosis are shown in Table 2. The median peak BK viral load prior to cidofovir administration was 77,580 copies/mL (IQR 28,358-322,318). Median time to cidofovir initiation after BKV diagnosis was 83 days (IQR 54-114), and treatment duration was 157 days (IQR 82-365). 17 patients (63%) received concomitant IVIG and median time to initiation was 2 months (IQR 1-3). Fluoroquinolones were used in 11 patients (41%) and initiated 4 months (IQR 2-6) after BKV diagnosis. Median time to clearance after BKV diagnosis was 19 months (IQR 12-25). Incidence of BKV clearance 3 months after cidofovir initiation occurred in 1 of 23 patients (4%) with available data. 5 of 13 patients (38%) cleared BKV at 12 months after cidofovir initiation. 6 patients (22%) experienced graft failure, of which 4 cases were due to BKV nephropathy. The median time to graft failure was 1030 days (IQR 625-1388). 96% of patients were alive at time of last follow-up. Median time to last follow-up was 1075 days (IQR 767-1530).
*Conclusions: Initiation of cidofovir did not appear to impact rate of BKV clearance by 3 months in our cohort. Further assessments will be completed to identify factors associated with BKV clearance in KT recipients.
To cite this abstract in AMA style:
Thornberg M, Hedvat J, Lange N, Brennan C, Salerno D, Tsapepas D. Effectiveness and Tolerability of Cidofovir for the Management of BK Viremia in Kidney Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/effectiveness-and-tolerability-of-cidofovir-for-the-management-of-bk-viremia-in-kidney-transplant-recipients/. Accessed May 11, 2025.« Back to 2020 American Transplant Congress