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Abstract: PUB665

Is Cidofovir an Option for Refractory BK Nephropathy?

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Jeyarajasingam, Aravindan V., Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Sanon, Julien, Einstein Healthcare Network, Cheltenham,, Pennsylvania, United States
  • Bradauskaite, Gitana, Einstein Medical Center, Philadelphia, Pennsylvania, United States
  • Yoganathan, Yamuna, Windsor University School of Medicine, Caledon, Ontario, Canada
  • Knorr, John P., Einstein Medical Center, Philadelphia, Pennsylvania, United States
Introduction

BK human polyomavirus typically seroprevalent in humans however BK appears to affect immunocompromised patients and cause clinical disease. In Kidney transplant patients, degree of immunosuppression is associated with BK viremia and nephropathy (BKVN) and has a prevalence of approximately 5 % in post kidney transplant patients. We present the case of a patient who underwent diseased donor renal transplant and developed BK viremia within a month of receiving her transplant. BK viremia was refractory to a reduction in the dose of her immunosuppressive agents, IVIG as well as Leflunomide. BK viremia responded significantly after initiation of intravenous cidofovir.

Case Description

42 year old female with past medical history including end stage renal disease due to diabetic nephropathy who underwent diseased donor renal transplant and patient had immediate graft function. Maintenance immunosuppression including Tacrolimus, Mycophenolate and Prednisone. She developed BK viremia with in first month after transplant; subsequently mycophenolate was discontinued, and she was started on Leflunomide and IVIG infusion. She received total of eight doses of IVIG. Due to worsening creatinine, patient underwent transplant graft biopsy #1 which showed stage A BK nephropathy with polyoma viral load (PVL) 1-10 %. Second renal biopsy four months later showed stage B BK nephropathy with a PVL > 3 % and SV 40 positive in cortex > 10%. Patient was started on Cidofovir intravenous infusion 0.5 mg/kg every 2 weeks with normal saline pre-treatment infusion 500 ml. The patient’s BK viremia started to trend down after initiation of cidofovir (figure 1).

Discussion

BK virus affects immunocompromised renal transplant patients. Transplant graft biopsy will give the definite diagnosis of BKVN with positive for SV40. BKVN thought to be secondary to over immunosuppression. The initial treatment for BK viremia includes lowering immunosuppression followed by IVIG as well as Leflunomide. In patients who are refractory to initial treatment, cidofovir can be a treatment option.