V-1647. Outcome of BK Nephropathy Treated with Cidofovir and Leflunomide in Renal Transplant Patients
Session: Poster Session: Miscellaneous Viruses
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: BK virus (BKV), a Polyoma virus, rarely causes significant disease. BKV nephropathy (BKN) occurs in up to 8% of renal transplant (RT) patients (pts) and is associated with renal allograft (RA) loss in 30-65% of cases. Treatment includes reduction in immunosuppression (IMS) (which increases the risk of RA rejection), Cidofovir (CD), Leflunomide (LF), IVIG, quinolones, and combinations thereof. This study presents the results of combination therapy (CT) using CD and LF for BKN in RT pts. Methods: A retrospective cross-sectional study of 8 pts with BKN was conducted from 11/22/04-4/7/08. Diagnosis of BKN was based on serum BK viral load (VL), increased serum creatinine (Crt), and/or kidney biopsy. After diagnosis of BKN, an RT nephrologist adjusted IMS. A new BK VL was determined between 6-154 days (in 7/8 patients) after IMS adjustment. Due to non-significant reduction in BK VL and/or improvement in serum Crt, CD (0.25-0.5 mg/kg weekly or bimonthly) and LF (100 mg daily for 5 days, followed by 20-60 mg daily to maintain serum levels between 50-100 ug/mL) were initiated. Weekly serum BUN/Crt and bimonthly serum BK VL and LF levels were measured. CD was withheld if Crt increased > 0.2 mg/dL between measurements. There was a mean follow-up of 42.9 weeks (wks) (range 6-83 wks). Results: 4/8 pts reached undetectable BKV (< 200 copies/mL) and CD and LF were discontinued. All pts had significant reductions (> 1 log) in VL after an average therapy of 16.8 wks (range 1-57 wks). There were no significant changes in the calculated Crt clearance, with an average delta change of 4.95 mL/min (range 0.43-9.92 mL/min). No RA loss or serious adverse events (AE) were reported. Conclusions: CT of CD and LF was effective in clearing or significantly reducing serum BK VL. No RA loss or significant reductions in RF were found at follow-up. No serious AE were reported when CT of CD and LF were used with caution.
Christopher Boshkos, MD1, Hector Bonilla, MD2, John Selickman, BA3, Laurie Morrison, RN1, Mihail Paxos, BS3, Robert Novak, MD4, Santosh Potdar, MD1 and  H. Bonilla, None., (1)Summa Health System, (2)Summa Health System, Akron, OH, (3)Northeastern Ohio Universities College of Medicine, (4)Akron Children's Hospital

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