Akademik Veri Yönetim Sistemi
e 21st Biennial European Society for Organ Transplantation (ESOT) Congress, Athens, Greece, Athens, Yunanistan, 17 - 20 Eylül 2023, ss.266
Background: The treatment options, other than immunosuppressive dose
reduction are very limited for BKV infected kidney transplant recipients. 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 (Ktx).
Methods: Data of patients with kidney transplantation between October 2013
and March 2022 were evaluated retrospectively in terms of BKV replication,
development of BKV nephropathy and efficacy of treatment modalities. Serum
BKV PCR was monitored monthly for the first six months and then every three
months. The treatment plan was everolimus/low-dose tacrolimus shift in the
first line 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.
Living donor Ktx was 91.8%, induction treatment was mostly anti-thymocyte
globulin (90.2%). Everolimus/low-dose tacrolimus exchange was applied in all
patients with BKV replication, complete response was obtained in 73.8% of
patients and BKV PCR became negative, partial response (BKV PCR >50%
regression) was observed in 13.1% of 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.
Conclusions: Replacing standard immunosuppressive therapy with everolimus/low-dose tacrolimus/steroid is 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 change