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A Novel Treatment Regimen for BK Viremia

Zaman, Rumina A.1; Ettenger, Robert B.1; Cheam, Hay1; Malekzadeh, Mohammed H.1; Tsai, Eileen W.1,2

doi: 10.1097/01.TP.0000441825.72639.4f
Clinical and Translational Research

Background: BK viremia, a prerequisite for BK virus nephropathy (BKVN), affects 5% to 16% of pediatric renal transplant recipients (PRTR). We evaluated the safety and efficacy of a novel approach to treating BK viremia using fluoroquinolones and leflunomide in PRTR.

Methods: We studied 230 PRTR at Mattel Children’s Hospital, UCLA, who underwent renal transplantation between January 2003 and October 2010. Nineteen patients were found to have BK viremia. Ciprofloxacin was started when the BK viral load was greater than 625 copies/mL, and patients were switched to leflunomide if BK viral load did not decrease after 2 months of ciprofloxacin therapy. All patients underwent transplant kidney biopsy, and their estimated glomerular filtration rate (eGFR) and BK PCR was measured serially. The side effects of ciprofloxacin and leflunomide were recorded in each patient.

Results: There was a significant decrease in BK viral load in patients treated with ciprofloxacin and leflunomide (P<0.001) with only a small reduction in immunosuppression. BK viremia was associated with a significantly decreased eGFR (P<0.001), and treatment with ciprofloxacin and leflunomide was associated with improved eGFR (P<0.001). This approach resulted in a BKVN rate of only 1%.

Conclusions: This analysis demonstrates for the first time that, used in a stepwise fashion, ciprofloxacin and leflunomide are effective and safe treatments for BK viremia in PRTR.

1 Mattel Children’s Hospital UCLA, Division of Pediatric Nephrology, Los Angeles, CA.

2 Address correspondence to: Eileen W. Tsai, M.D., Mattel Children’s Hospital UCLA, Division of Pediatric Nephrology, Box 951752, Los Angeles, CA, 90095-1752.

This study was funded by Casey Lee Ball Foundation.

The authors declare no conflicts of interest.

E-mail: etsai@mednet.ucla.edu

R.A.Z. participated in research design, performance of the research, writing of the paper, and data analysis. R.B.E. participated in research design and writing of the paper. H.C. participated in research design and performance of research. M.H.M. participated in writing of the paper. E.W.T. participated in research design, writing of the paper, and data analysis.

Received 15 April 2013. Revision requested 15 May 2013.

Accepted 21 November 2013.

© 2014 by Lippincott Williams & Wilkins