Polyomavirus in Renal Transplantation: A Hot Problem

Bonvoisin, Catherine; Weekers, Laurent; Xhignesse, Patricia; Grosch, Stéphanie; Milicevic, Mladen; Krzesinski, Jean-Marie

doi:10.1097/tp.0b013e318169c794

Cited by 72 publications

(78 citation statements)

References 46 publications

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“…17 UTI was the most common late serious infection, as was reported previously, 18 and CMV and BK polyomavirus infection rates with belatacept were similar to published results in CNItreated patients. 19,20 Our study was not powered to detect a difference in outcomes between the 4-and 8-week dosing groups; therefore, safety and efficacy were primarily analyzed using pooled data from both groups. There were no substantive differences in GFR or death/graft loss between the two dosing groups, however, there was a higher incidence of AR with the 8-week dosing.…”

Section: Discussionmentioning

confidence: 99%

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Vincenti

Blancho

Dürrbach

et al. 2010

Journal of the American Society of Nephrology

175

139

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Belatacept is a first-in-class co-stimulation blocker in development for primary maintenance immunosuppression. A Phase II study comparing belatacept with cyclosporine (CsA) for prevention of acute rejection and protection of renal function in kidney transplant recipients demonstrated similar efficacy and significantly higher measured GFR at 1 year for belatacept, but the incidence of posttransplantation lymphoproliferative disorder was higher. Here, we present the results for the extension of this trial, which aimed to assess long-term safety and efficacy of belatacept. Seventy-eight of 102 patients who were receiving belatacept and the 16 of 26 who were receiving CsA completed the long-term extension period. GFR remained stable in patients who were receiving belatacept for 5 years, and the incidences of death/graft loss or acute rejection were low. The frequencies of serious infections were 16% for belatacept and 27% for CsA, and neoplasms occurred in 12% of each group. No patients who were treated with belatacept and one patient who was treated with CsA developed posttransplantation lymphoproliferative disorder during the follow-up period. Serious gastrointestinal disorders occurred more frequently with belatacept (12% belatacept versus 8% CsA), and serious cardiac disorders occurred more frequently with CsA (2% belatacept versus 12% CsA). Pharmacokinetic analyses showed consistent exposure to belatacept over time. CD86 receptor saturation was higher in patients who were receiving belatacept every 4 weeks (74%) compared with every 8 weeks (56%). In conclusion, this study demonstrated high patient persistence with intravenous belatacept, stable renal function, predictable pharmacokinetics, and good safety with belatacept over 5 years.

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Section: Discussionmentioning

confidence: 99%

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Vincenti

Blancho

Dürrbach

et al. 2010

Journal of the American Society of Nephrology

175

139

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“…These viruses rarely are associated with disease in immunocompetent individuals. During periods of immunosuppression the virus is reactivated and can be associated with significant morbidity (1)(2)(3).…”

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confidence: 99%

“…Polyomaviruses belong to a family of small, circularized, double-stranded DNA viruses called Papovaviridae (1)(2)(3). Twelve members of the polyomavirus family have been described in a variety of species including mice, monkeys, and humans, with SV40 being the most studied (4).…”

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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“…En el caso 2, optamos por el uso de la inmunoglobulina, también utilizada en el tratamiento de complicaciones infecciosas virales asociadas al trasplante, como CMV, enfermedad de virus Epstein Barr (EBV) / desorden linfoproliferativo postrasplante (PTLD) e infección parvovirus B19 (32,33) . Se describe que la inmunoglobulina posee acción de anticuerpo antipoliomavirus (33) .…”

Section: Discussionunclassified

“…Se describe que la inmunoglobulina posee acción de anticuerpo antipoliomavirus (33) . La racionalidad del uso de la inmunoglobulina en el manejo de NPBK está también basada en la potencial transferencia de su inmunidad protectora (32) .…”

Section: Discussionunclassified

Nefropatía asociada a poliomavirus BK en trasplante renal

et al. 2016

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ResumenEl objetivo del presente reporte es dar a conocer los dos primeros casos de nefropatía del injerto asociada a poliomavirus BK (NPBK) ocurridos en el Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Perú. El diagnóstico definitivo de la NPBK se corroboró mediante biopsia renal y estudio de microscopia electrónica. En el caso 1, el deterioro funcional renal no se controló a pesar de reducir la inmunosupresión y añadir drogas antivirales (leflunamide y ciprofloxacina), evolucionando a falla renal y su posterior acceso a retrasplante renal. En el caso 2, la alternativa terapéutica se basó en infusión de inmunoglobulina endovenosa asociada a reducción de la inmunosupresión, resultando en moderada mejora histológica y estabilización de la función renal. En ambos injertos renales hubo concomitantemente NPBK y lesiones histológicas compatibles con rechazo agudo celular pendientes de interpretar. En conclusión, la presencia del poliomavirus BK representa serio problema en el riñón trasplantado. La mejor conducta terapéutica se basa en el diagnóstico precoz y subsecuente reducción de la inmunosupresión. Es imprescindible disponer de metodología apropiada que posibilite un diagnóstico preciso. Se utiliza tamizaje de células señuelo o marcadoras (decoy cells) en orina, reacción de cadena polimerasa (PCR), biopsia renal o la microscopia electrónica como método valioso de ayuda en el diagnóstico etiológico viral. Se considera el retrasplante como opción ante la pérdida del injerto por NPBK (caso 1). Palabras clave. Poliomavirus BK; Nefropatía; Trasplante de riñón; Inmunología. Abstract Two documented cases of BK polyomavirus-associated nephropathy (BKVN) seen at Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Peru are reported. Final BKVN diagnosis was confirmed by renal biopsy and electron microscopy study. Case 1: Renal functional deterioration was not controlled despite reduction of immunosuppression and addition of antiviral drugs (leflunomide and ciprofloxacin), evolving to renal failure and subsequent kidney retransplantation. Case 2: The therapeutical management consisted in intravenous immunoglobulin infusion linked to reduction of immunosuppression; this resulted in modest histological improvement and stabilization of renal function. Both renal grafts concomitantly presented BKVN and histological lesions consistent with acute rejection, pending interpretation. In conclusion presence of BK polyomavirus is a serious problem for transplanted kidneys. The best treatment is based on early diagnosis and subsequent reduction of immunosuppression. It is essential to have an appropriate methodology for precise diagnosis. Early electron microscopy is a valuable method for viral etiologic diagnosis. Retransplantation is considered a treatment option when faced with possible BKVN-related graft loss (Case 1). Keywords. BK polyomavirus; Nephropathy; Kidney transplantation; Immunology.

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Polyomavirus in Renal Transplantation: A Hot Problem

Cited by 72 publications

References 46 publications

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

Five-Year Safety and Efficacy of Belatacept in Renal Transplantation

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

Nefropatía asociada a poliomavirus BK en trasplante renal

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