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Prolonged Fluoroquinolone Prophylaxis to Prevent BK Viremia in Kidney Transplant Recipients

S. A. Muhsin1, S. J. Ripley2, M. L. Jacobs3, K. Safa1, D. M. Wojciechowski1

1Nephrology Division, MGH, Boston, MA, 2Cancer Center, MGH, Boston, MA, 3Wake Forest University School of Medicine, Winston-Salem, NC

Meeting: 2019 American Transplant Congress

Abstract number: C259

Keywords: Kidney transplantation, Polyma virus, Prophylaxis

Session Information

Date: Monday, June 3, 2019

Session Name: Poster Session C: Kidney: Polyoma

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

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  • Impact of Donor and Recipient BKV Serostatus and the Effect of Ciprofloxacin Prophylaxis on BK Viremia Risk After Kidney Transplant

*Purpose: Prophylaxis for kidney transplant recipients has successfully lowered early incidence of infections such as CMV. However, there are no approved agents for the prevention of BKV infection. Fluoroquinolone prophylaxis over 1 and 3 month durations has demonstrated mixed results

*Methods: We retrospectively evaluated the 1 year incidence of BK viremia in patients who did (n=15) or did not (n=76) receive 6 months of fluoroquinolones post-transplant (levofloxacin 250 mg daily, or ciprofloxacin 250-500 daily, fixed dosing). Inclusion criteria included BK viremia screening that was performed at least twice during the first-year post transplant including one screening at the one year post-transplant mark. We compared patient and transplant demographics, induction and maintenance immunosuppression, and graft function. The primary outcome was the 1 year incidence of BK viremia

*Results: The groups did not differ significantly in demographic/transplant variables (Table 1). The no prophylaxis groups had lower tacrolimus trough levels at 6 months post transplant (p=0.0364) and received lower doses of steroids at 12 months post transplant (p=0.0181). The median number of BK screening tests over 1 year was 4 and 6 in the 6 month prophylaxis and no prophylaxis groups, respectively (p<0.0001). The incidence of BK viremia at one year was 6.7% and 25% in the 6 month prophylaxis and no prophylaxis groups, respectively (p=0.1171). There were no cases of BK virus associated nephropathy in either group. Three cases of acute rejection developed in the no prophylaxis group, while one case developed in the 6 month prophylaxis group (p=0.6387). In the 6 month prophylaxis group, there were no incidences of tendonitis or tendon rupture during the prophylaxis period

*Conclusions: 6 months of fluoroquinolone prophylaxis resulted in a numerically lower incidence of BK viremia that was not statistically significant. Though the prophylaxis group had fewer BK screening tests, all patients had screening at the 1 year mark that we hypothesize should have detected the presence of BK viremia as immunosuppression was otherwise unchanged. This strategy and its safety warrant evaluation in a larger cohort of patients

Patient and Transplant characteristics
Prophylaxis (n=15) No prophylaxis (n=76) P value
Age (years) (SD) 55.09 (10.33) 54.3 (11.8) 0.9873
Sex, female, n(%) 8 (53.33) 25 (32.8) 0.1511
Living Kidney Transplant, n(%) 9 (60) 26 (34.21) 0.0824
DGF, n(%) 5 (33.33) 20 (26.31) 0.5779
Stent at transplant, n(%) 10 (66.66) 46 (60.52) 0.6551

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To cite this abstract in AMA style:

Muhsin SA, Ripley SJ, Jacobs ML, Safa K, Wojciechowski DM. Prolonged Fluoroquinolone Prophylaxis to Prevent BK Viremia in Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/prolonged-fluoroquinolone-prophylaxis-to-prevent-bk-viremia-in-kidney-transplant-recipients/. Accessed February 27, 2021.

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