Efficacy of Intravenous Immunoglobulin in the Treatment of
Persistent BK Viremia and BK Virus Nephropathy in Renal Transplant Recipients.
Tariq Shah, Don Vu, Robert Naraghi, Annabelle Campbell, and
David Min
Clinical Transplants 2014, Chapter 13
Abstract
BK virus associated nephropathy (BKVN) can cause clinically
significant viral infections in renal transplant recipients, leading to
allograft dysfunction and loss. The usual management of BKVN involves reduction
of immunosuppression and the addition of leflunomide, quinolones, and
cidofovir, but the rate of graft loss remains high. The aim of this study was
to assess the impact of treatment with intravenous immunoglobulin (IVIG) on the
outcome of BKVN in renal transplant recipients.
Upon diagnosis of BKVN, patients remained on
anti-polyomavirus treatment consisting of reduction of immunosuppression and
the use of leflunomide therapy. Treatment with IVIG was given only to patients
who did not respond to 8 weeks of the adjustment of immunosuppression and
leflunomide.
All 30 patients had persistent BK viremia and BKVN with
their mean BK viral loads higher than the baseline (range 15,000 – 2 millions
copies/ mL). Mean peak BK load was 205,314 copies/mL compared to 697 copies/mL
after one year follow-up. Twenty-seven patients (90%) had positive responses in
clearing viremia. The actuarial patient and graft survival rates after 12
months were 100% and 96.7 %, respectively.
IVIG administration appeared to be safe and effective in
treating BK viremia and BKVN and in preventing graft loss in patients who had
inadequate response to immunosuppression reduction and leflunomide therapy.
Efficacy of Intravenous Immunoglobulin in the Treatment of Persistent BK Viremia and BK Virus Nephropathy in Renal Transplant Recipients
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