*Purpose: Polyoma BK virus nephropathy (BKVN) of KTRs is associated with adverse outcome, since no specific therapy exists. EVR showed promising antiviral effects but systematic prospective studies are lacking.

*Methods: Therefore, ten consecutive KTRs with biopsy-proven BKVN were converted to EVR with reduced exposure CNI, and MMF discontinuation. Ten patients not administered EVR, served as controls. All patients underwent kidney graft biopsy, BKV replication by PCR, and de novo DSA determination.

*Results: During a 3-year follow-up no graft loss occurred in KTRs on EVR but it was observed in 5/10 controls (P=0.032). eGFR improved in EVR and worsened in controls (between-group difference +25.0, 95% CI 9.8 to 45.2, P=0.003). BKV replication regressed in the EVR group alone (from 6.4±0.8 to 3.6±1.6 Log₁₀ genomic copies, P=0.0001), and a significant inverse relationship was found between eGFR and BKV genomic copy changes (P=0.036). By multivariable Cox regression analysis, EVR resulted the only significant predictor of a combined endpoint of graft loss and 57% eGFR reduction (P=0.03). Better survival free of adverse graft outcome was observed in KTRs on EVR (log-rank test, P=0.009).

*Conclusions: In conclusion, an EVR-based immunosuppressive protocol characterized by minimization of CNI and antimetabolite discontinuation proved to be effective for treating BKVN in KTRs.

« Back to 2020 American Transplant Congress