Akademik Veri Yönetim Sistemi
17th BANTAO Congress, Antalya, Türkiye, 10 - 13 Kasım 2022, ss.15-16
Introduction: The treatment of BKV infection in kidney transplant patients, other than immunosuppressive dose reduction, treatment options with proven efficacy are limited. In this study, current treatment options, especially changing the standard treatment to everolimus/low-dose tacrolimus, were evaluated in patients who developed BKV infection or nephropathy after kidney transplantation.
Method: Data of patients with kidney transplant between October 2013 and March 2022 were evaluated retrospectively in terms of BKV replication, development of BKV nephropathy and efficacy of treatment modalities. BKV PCR was monitored monthly for the first six months and then every three months. The initial treatment plan was everolimus/low-dose tacrolimus shift in the first step after then, IVIG, Leflunamide, or Cidofovir , depending on the clinical situation.
Results: A total of 646 patients were evaluated, 61 patients (9.4%) who had BKV replication (mean age 47.3±12.3 years, 67.2% males) were identified. Kidney transplantation from living donors was 91.8%, induction treatment was 90.2% anti-thymocyte globulin (ATG). Everolimus/low-dose tacrolimus exchange was applied in all patients with BKV replication, complete response was obtained in 73.8% of patients with the first-line approach and BKV PCR became negative, partial response (BKV PCR >50% regression) was observed in 13.1% patients. Nine patients did not respond to first-line treatment; complete response was obtained with IVIG in one patient and partial response with IVIG + Leflunamide in one another. Various combinations of cidofovir, IVIG/Leflunomide were used in a total of seven patients, partial response in only one patient, impaired allograft function in three patients, and allograft loss in three patients. Allograft function was preserved according to the basal creatinine level (1.16±0.36mg/dl vs. 1.58±1.06mg/dl, p=0.81) in those who responded to treatment in the first step.
Conclusion: Replacing standard immunosuppressive therapy with everolimus/low-dose tacrolimus/steroid is still the most effective approach in BKV infection developing after kidney transplantation. Early intervention with frequent BKV replication monitoring is appropriate for treatment effectiveness. Current treatment options seem unlikely to be successful in patients who do not benefit from first-line immunosuppressive changes.