Purpose: Various anecdotal reports have described clinical activity of cidofovir, leflunomide, and ciprofloxacin in clearing the BK virus. Our aim was to define the factors predicting BK viral clearance; and to identify the best treatment for BK viremia today, if any.
Methods: We prospectively screened 609 kidney or kidney/pancreas recipients from January 2007 to June 2011 for BK viremia using quantitative PCR. By 1-year, 130 (21.3%) had at least one positive BKV PCR. We classified patients with BK viremia according to the treatment received into 5 groups: Observation Alone n=45; Decrease (30-50%) or Stop Immunosuppression (IS) n=43; Decrease or Stop IS +Cipro n=14; Decrease or Stop IS + Leflunomide n=18; or Decrease or Stop IS + Cipro + leflunomide n=11. Patients with BK viremia were further classified into those that cleared the virus for at least 3 consecutive months: n=101/130, 78%) and those that did not: n=29/130, 22%) to identify significant factors associated with viral clearance using univariable and multivariable analysis. We plotted the mean BK viral loads for each of the 5 treatment groups in a scattered plot graph, and compared the slopes of decline of BK viral loads.
Results: Factors associated with BK viral clearance were: Lower peak viral loads (p <0.001), lower viral loads at first detection (p=0.021), non doubling of the BK viral load compared to first detection (p <0.001, HR=5.5, 95% CI 3.2-9.6), recipient female gender (p=0.007, HR=1.6, 95% CI 0.4-0.9), and recipient CMV seronegative (P=0.04, HR=1.6, 95% CI 0.4-0.9). In addition, any 10,000 copies/mL increase in BK viral load compared to first detection decreased chance of clearance by 50% (p=0.038, HR=0.499, 95% CI 0.3-0.96). The 5 slopes were parallel to each other with no significant difference in the rate of BK viral load decline (p=0.16).
Conclusions: Lower BK viral loads at first detection and peak, absence of doubling compared to first detection, recipient female gender and CMV negative serostatus are significantly associated with BKV clearance. The evidence does not support increased viral clearance when leflunomide or cipro are added to a 30-50% reduction in overall IS.
To cite this abstract in AMA style:Elfadawy N, Flechner S, Liu X, Schold J, Fatica R, Srinivas T, Poggio E, Avery R, Mossad S. What Is the Best Treatment for BK Viremia after Kidney Transplantation: Results of a 5-Year Screening Study [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/what-is-the-best-treatment-for-bk-viremia-after-kidney-transplantation-results-of-a-5-year-screening-study/. Accessed April 19, 2021.
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