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Observations on the use of cidofovir for BK virus infection in renal transplantation
Author(s) -
Kuten S.A.,
Patel S.J.,
Knight R.J.,
Gaber L.W.,
DeVos J.M.,
Gaber A.O.
Publication year - 2014
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12313
Subject(s) - cidofovir , bk virus , medicine , polyomavirus infections , immunosuppression , nephropathy , parvovirus , viremia , urology , transplantation , renal function , interquartile range , kidney transplantation , odds ratio , gastroenterology , immunology , virus , endocrinology , diabetes mellitus
Abstract Background In renal transplantation, BK virus infection can result in significant graft nephropathy and loss. While reduction in immunosuppression ( IS ) is considered standard therapy, adjunct agents may be warranted. Data are suggestive of a possible role of cidofovir for the management of BK . This study aims to describe the course of BK viremia ( BKV ) in a large cohort of renal transplant patients receiving adjunct cidofovir. Methods We evaluated kidney and kidney‐pancreas recipients who received cidofovir combined with reduced IS for management of high‐level BKV or BK virus nephropathy ( BKVN ). We examined the rate and timing of BKV clearance, and performed a multivariate analysis to identify risk factors associated with long‐term (>6 months) viremia. Results In total, 75 patients received a median of 13 doses of cidofovir in conjunction with reduced IS ; 32 patients (43%) had short‐term BKV (≤6 months), and 43 (57%) had long‐term BKV . Overall, 53 of 75 patients (71%) eventually cleared BKV at a median of 4.2 months (interquartile range 2.1–9.3 months). Independent factors associated with long‐term BKV included older age (odds ratio [ OR ] 1.1, P = 0.02), delayed graft function ( OR 31.4, P = 0.01), and higher peak BKV ( OR 12.8, P = 0.02), while BKV reduction by at least 1 log 10 copies/mL at 1 month of treatment was associated with clearance within 6 months ( OR 49.3, P < 0.01). Patients with earlier clearance maintained stable graft function and no graft losses, while long‐term BKV was associated with a 15% decline in estimated glomerular filtration rate. Conclusions Adjunct cidofovir resulted in preservation of renal function when viral clearance occurred within 6 months of initiation. This retrospective review defines factors predicting response to cidofovir in conjunction with reduced IS for BKVN or high‐level BKV . Still, considering cost, frequency of administration, and treatment duration, a randomized trial is necessary to define the exact utility of cidofovir in the setting of BK virus infection.