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BK virus nephropathy after simultaneous pancreas–kidney transplantation
Author(s) -
Akpinar Edip,
Ciancio Gaetano,
Sageshima Jun,
Chen Linda,
Guerra Giselle,
Kupin Warren,
Roth David,
Ruiz Phillip,
Burke George
Publication year - 2010
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2009.01204.x
Subject(s) - medicine , immunosuppression , urology , tacrolimus , thymoglobulin , kidney transplantation , transplantation , kidney , renal function , pancreas transplantation , gastroenterology , daclizumab , nephropathy , chronic allograft nephropathy , surgery , endocrinology , diabetes mellitus
Akpinar E, Ciancio G, Sageshima J, Chen L, Guerra G, Kupin W, Roth D, Ruiz P, Burke G. BK virus nephropathy after simultaneous pancreas–kidney transplantation.
Clin Transplant 2010: 24: 801–806. © 2010 John Wiley & Sons A/S. Abstract: Background: BK virus nephropathy (BKVN) was reported in up to 7.5% of patients after simultaneous pancreas–kidney transplantation (SPK). Its management by reduction in immunosuppression might pre‐dispose to pancreatic graft loss. Methods: A retrospective analysis of 178 SPK recipients was performed. All patients received thymoglobulin, daclizumab and a maintenance of low‐dose steroids, tacrolimus, and either sirolimus or mycophenolate. Results: Two (1.1%) patients were identified with BKVN. Time of diagnosis was 22 and 45 months after transplant. Both patients had superimposed calcineurin toxicity in their graft biopsies. Immunosuppression was reduced in both patients, and leflunomide (LEF) was used in one patient. Concurrent kidney rejection episodes were treated with steroid pulses in both patients. One kidney graft improved with a last estimated glomerular filtration rate (GFR) of 43 mL/min, and another kidney graft showed limited improvement with a last GFR of 30 mL/min. Pancreatic graft function remained excellent in both patients as assessed by serum c‐peptide, glycosylated hemoglobin, amylase‐lipase, and urine amylase levels. Conclusion: Low incidence of BKVN was observed in our SPK series. Reduction in immunosuppression and sometimes LEF can be effective. The underlying mechanism of stable pancreatic allograft function despite ongoing kidney rejection warrants further investigation.