Faculty Collaboration Database

Successful treatment of BK viremia using reduction in immunosuppression without antiviral therapy. Transplantation 2008 Mar 27;85(6):850-4

Date

03/25/2008

Pubmed ID

18360267

DOI

10.1097/TP.0b013e318166cba8

Scopus ID

2-s2.0-41149157586 (requires institutional sign-in at Scopus site)   92 Citations

Abstract

BACKGROUND: Treatment of BK virus (BKV) infection in renal transplant recipients remains controversial. This retrospective analysis evaluated efficacy and safety of reducing immunosuppression without antiviral therapy.

METHODS: This single center analysis included 24 patients diagnosed with BK viremia between September 2001 and December 2003. Sixteen patients (66%) presented with BKV nephritis and eight patients (34%) presented with viremia without evidence of nephritis on renal biopsy.

RESULTS: At time of diagnosis, mean plasma BKV DNA (copies/mL) was 460,409 (range 10,205-1,920,691). Mean doses reduction of mycophenolate mofetil and tacrolimus were 44% and 41%, respectively, from time of diagnosis of BKV infection to complete resolution of viremia. A decline in BK viral load was noticed within 15 to 30 days, with successful elimination of viremia over a mean period of 5.8 months (range, 1-9.5). Mean serum creatinine at time of diagnosis of BK viremia was 1.8 mg/dL (range, 1.2-2.8). Mean follow-up period is 30.9 months postdiagnosis. At the most recent visit, serum creatinine was 2.0 mg/dL (range, 1.0-3.6) (P=0.14). With reduction in immunosuppressive therapy, three patients (13%) developed acute cellular rejection and were treated successfully with intravenous bolus steroids. During follow-up, one patient had a relapse of BKV nephritis during pregnancy and lost her graft. After mean follow-up period of 43.5 months posttransplantation, all 24 patients are alive and 23 have a functioning graft. Seventeen patients (71%) have stable or improved graft function.

CONCLUSION: Our analysis shows that reduction in immunosuppression therapy alone results in clearance of the BK viremia with good long-term outcome.

Author List

Saad ER, Bresnahan BA, Cohen EP, Lu N, Orentas RJ, Vasudev B, Hariharan S

Authors

Barbara A. Bresnahan MD Professor in the Medicine department at Medical College of Wisconsin
Ehab R. Saad MD Director, Professor in the Medicine department at Medical College of Wisconsin
Brahm Vasudev MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Aged
BK Virus
Dose-Response Relationship, Drug
Female
Graft Rejection
Humans
Immunosuppressive Agents
Kidney Diseases
Kidney Transplantation
Male
Middle Aged
Mycophenolic Acid
Polyomavirus Infections
Postoperative Complications
Prednisone
Tacrolimus
Tumor Virus Infections