Low‐dose cidofovir and conversion to mTOR‐based immunosuppression in polyomavirus‐associated nephropathy. Issue 2 (16th December 2019)

• Record Type: Journal Article
• Authors: Mühlbacher, Thomas; Beck, Robert; Nadalin, Silvio; Heyne, Nils; Guthoff, Martina
• Is Part Of: Transplant infectious disease. Volume 22:Issue 2(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-12-16
• Subjects: BKV -- cidofovir -- mTOR -- polyoma -- polyomavirus‐associated nephropathy -- renal transplantation; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.13228
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: 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.