BK Nephropathy Treatments in Kidney Transplant Recipients

Le résumé fourni par la source

Background: BK virus is a polyoma virus(BKPyV) and an important cause of allograft loss in kidney transplant recipients(KTR). Currently there are no effective treatments for BKPyV with centres using combination therapies strategies. It is unclear whether the increase in BK viraemia is due to immunosuppression(IS), assays or screening. We looked to determine the treatments used for management of BK in our centre. Methods: An observational retrospective single centre experience looking at BKPyV. All KTR 2001-2023 with detectable BK(plasma/urine) were identified from the electronic renal database(cv5). Maintenance IS regimens were recorded: Tacrolimus(Tac), Mycophenolate Mofetil(MMF), Prednisolone(P), Sirolimus(Sir) and Azathioprine(Aza). BKpyV erradication treatments included; reduction of MMF(1), cessation of MMF(2) reduction in Tac(3), introduction of Ciprofloxacin(Cip)(4), Leflunomide(5), P(6) and cessation of Aza(7). Results: 7%(37/525) KTR were found to have BKPyV(34 viraemia,3 viuria) between 2001-2023. 10 female,27 male. Median age 59yrs(26-84yrs). 9 White, 10 Asian, 7 Black, 4 Chinese, 4 Other, 3 Unknown. Primary kidney disease: IgA 8, CKD 7, FSGS 4, Renovascular 2, T2DM 2, Congenital kidney disease 1, Glomerulonephritis 3, Malignant hypertension 1, APKD 3, SLE 2, Unknown 4. BK occurred following treatment for rejectionx2, 1xdrain removal and 1xureteric stent removal. 3 KTR had biopsy proven BK nephropathy. Peak BKPyV viraemia 2.9 million copies/ml, peak viruria 1.28E+10 copies/ml. BKPyV viraemia median 3mths post-transplant(1mth-8yrs), viuria median 4 months(1mth-12yrs). Treatments included; 2 KTR (1,3), 1 KTR (1,3,4), 7 KTR (1,3,6), 3 KTR (1,3,4,6), 1 KTR (1,3,5,6), 1 KTR (2,3,4), 2 KTR (2,3,6), 8 KTR with (2,3,4,6), 7 KTR (2,3,4,5,6), 1 KTR (2,3,5,6), 1 KTR (2,3,6,7),1 KTR (3), 1 KTR (3,4,6), 1 KTR (3,6) and 1 KTR no changes. Commonest treatment was cessation of MMF, reduction in Tac, Cip ranging from 2-12wks and P with maintenance therapy of Tac+P. 5 KTR had 1 recurrence of BKPyV viraemia, 4 KTR had 2 episodes of recurrence with prolonged treatment with Cip. Remission of BKPyV was between 1mth-12yrs (median 2yrs). Conclusion: Over 22 yrs our centre has used a variety of treatments for BKPyV. Remission was seen in 28 KTR. The commonest intervention was to stop MMF however, despite these interventions 4 KTR lost their allografts highlighting the ineffective treatments for BK.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.