BK virus nephritis: Risk factors, timing, and outcome in renal transplant recipients

Vasudev, Brahm; Hariharan, Sundaram; Hussain, Syed A.; Zhu, Yong-Ran; Bresnahan, Barbara A.; Cohen, Eric P.

doi:10.1111/j.1523-1755.2005.00602.x

Cited by 226 publications

(212 citation statements)

References 19 publications

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“…The diagnosis of BKVAN was made at a median time of 15 mo after transplant (range, 5.5 to 90 mo). These findings are consistent with prior reports (20) and suggest that the diagnosis of BKVAN is often made following a significant decline in renal function. The demographic data of these 35 recipients are provided in Table 2.…”

Section: Resultssupporting

confidence: 82%

“…Vasudev et al (20) quantified the degree of immunosuppression reduction at diagnosis of BKVAN by a point-scale. Following an approximately 40% reduction in overall immunosuppression and a 70% reduction in CNI exposure, 9 of 25 subjects experienced graft loss in a median follow-up period of 8 mo, with evidence that CNI reduction correlated with a slower rate of decline of GFR (20). Although suboptimal, these outcomes are still generally better than smaller series reported in the literature (3,23).…”

Section: Discussioncontrasting

confidence: 46%

See 1 more Smart Citation

Aggressive Immunosuppression Minimization Reduces Graft Loss Following Diagnosis of BK Virus-Associated Nephropathy

Weiss¹,

Gralla²,

Chan³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Results: Of 910 kidney transplants, 35 (3.8%) cases of BKVAN were diagnosed at a median of 15 months after transplant (range, 5.5 to 90 months after transplant), 16 (46%) of which progressed to graft failure at a median of 11 months (range, 2 to 36 months) after diagnosis. Depleting antibody induction was a significant risk factor for graft loss on univariate analysis, whereas early drug withdrawal (<1 mo following diagnosis) protected against graft loss. On multivariate analysis, these findings were independent predictors of graft outcomes. Additionally, when patients were comanaged by referring nephrologists and the transplant center before the diagnosis of BKVAN, the risk of graft loss was 11-fold higher (P ‫؍‬ 0.03) than if patients were managed solely by the transplant center.Conclusions: Increased awareness and early diagnosis of BKVAN, with aggressive tapering of immunosuppression once established, is critical to preserve kidney graft function. Early drug withdrawal to low-dose two-drug therapy maintenance may be preferable to a general reduction of agents.

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Section: Resultssupporting

confidence: 82%

Section: Discussioncontrasting

confidence: 46%

Aggressive Immunosuppression Minimization Reduces Graft Loss Following Diagnosis of BK Virus-Associated Nephropathy

Weiss¹,

Gralla²,

Chan³

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…In early BK viral nephropathy, reduction of immunosuppression may be sufficient, 3-year graft survivals of 88%e100% being reported [17,18]. In those and other studies, viremia cleared in 92%e95% of patients, with a mean time to clearance of 54 days [18,19].…”

Section: Treatmentmentioning

confidence: 79%

“…Generally, the antimetabolite (MMF or azathioprine) is first withdrawn and the intensity of other immunosuppressive therapy is reduced. Both cyclosporine and sirolimus has been shown to inhibit BK viral reactivation in vitro and therefore a conversion from tacrolimus to cyclosporine or sirolimus might be considered [17].…”

Section: Treatmentmentioning

confidence: 99%

Late-Onset BK Viral Nephropathy in a Kidney Transplant Recipient

Mathew

Holanda

Figanbaum

et al. 2014

Transplantation Proceedings

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“…Other possible risk factors include increased age, male gender, Caucasian race, diabetes mellitus, and acute rejection (12)(13)(14). Some donor-related risk factors are the presence of active BKV or cytomegalovirus (CMV) infection and deceased donor versus living donor transplant (12)(13)(14).…”

mentioning

confidence: 99%

Evaluation of Fluoroquinolones for the Prevention of BK Viremia after Renal Transplantation

Gabardi

Waikar²,

Martin³

et al. 2010

Clinical Journal of the American Society of Nephrology

101

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Background and objectives: Nearly 30% of renal transplant recipients develops BK viremia, a prerequisite for BK nephropathy. Case reports have evaluated treatment options for BK virus, but no controlled studies have assessed prophylactic therapies. Fluoroquinolone antibiotics were studied for prevention of BK viremia after renal transplantation.Design, setting, participants, & measurements: This retrospective analysis evaluated adult renal transplant recipients with at least one BK viral load (blood) between 90 and 400 days after transplantation. Six to 12 months of co-trimoxazole was used for Pneumocystis prophylaxis. In sulfa-allergic/-intolerant patients, 6 to 12 months of atovaquone with 1 month of a fluoroquinolone was used. Fluoroquinolones can inhibit BK DNA topoisomerase. The two groups studied were those that received 30 days of levofloxacin or ciprofloxacin after transplantation and those that did not. The primary endpoint was BK viremia rates at 1 year. Of note, of the 160 patients not receiving fluoroquinolone prophylaxis, 40 received a fluoroquinolone for treatment of a bacterial infection within 3 months after transplantation. Subgroup analysis evaluating these 40 patients against the 120 who had no exposure to fluoroquinolones was completed.Results: A 1-month fluoroquinolone course after transplantation was associated with significantly lower rates of BK viremia at 1 year compared with those with no fluoroquinolone. In the subgroup analysis, exposure to fluoroquinolone for treatment of bacterial infections within 3 months after transplantation was associated with significantly lower 1-year rates of BK viremia.Conclusions: This analysis demonstrates that fluoroquinolones are effective at preventing BK viremia after renal transplantation.

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BK virus nephritis: Risk factors, timing, and outcome in renal transplant recipients

Cited by 226 publications

References 19 publications

Aggressive Immunosuppression Minimization Reduces Graft Loss Following Diagnosis of BK Virus-Associated Nephropathy

Aggressive Immunosuppression Minimization Reduces Graft Loss Following Diagnosis of BK Virus-Associated Nephropathy

Late-Onset BK Viral Nephropathy in a Kidney Transplant Recipient

Evaluation of Fluoroquinolones for the Prevention of BK Viremia after Renal Transplantation

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