Premium
Low‐dose cidofovir and conversion to mTOR‐based immunosuppression in polyomavirus‐associated nephropathy
Author(s) -
Mühlbacher Thomas,
Beck Robert,
Nadalin Silvio,
Heyne Nils,
Guthoff Martina
Publication year - 2020
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.13228
Subject(s) - cidofovir , immunosuppression , medicine , urology , bk virus , nephropathy , transplantation , polyomavirus infections , adverse effect , sirolimus , kidney transplantation , gastroenterology , surgery , immunology , virus , endocrinology , diabetes mellitus
Background Polyomavirus‐associated nephropathy (PVAN) remains a relevant complication following kidney transplantation with allograft loss rates of up to 50%. Reduction in overall immunosuppression is a cornerstone of therapy, whereas no specific antiviral regimen has shown conclusive benefit to date. The present case series demonstrates the efficacy of a dual therapeutic approach with low‐dose cidofovir and conversion to mTOR‐based immunosuppression in PVAN. Methods Patients with biopsy‐proven PVAN having received low‐dose cidofovir (0.25 mg/kg) according to the Tübingen Cidofovir Protocol and been converted to mTOR‐based immunosuppression were analyzed retrospectively. Results Twenty‐three patients with a median follow‐up of 2.24 [IQR 1.55‐5.01] years were included in the analysis. Median time to PVAN diagnosis was 268 [IQR 153‐869] days after transplantation. Polyomavirus clearance from plasma was achieved in 78% of patients after a median of 118 [IQR 76‐293] days. Of the 23 patients, nine patients (39%) lost their allograft function during follow‐up, but only three of these (13%) due to PVAN. Fourteen patients (61%) stabilized or improved allograft function. The cidofovir protocol allowed for specific antiviral therapy without adverse nephrotoxicity, even in patients with low allograft function. Conclusions Low‐dose cidofovir and conversion to mTOR‐based immunosuppression allow for effective virus clearance and preservation of allograft function in a high proportion of patients with PVAN and progressive allograft dysfunction and may prolong allograft survival in these patients.