Leflunomide treatment for polyomavirus BK-associated nephropathy after kidney transplantation.
Polyomavirus-associated nephropathy (PVAN) affects 1-10% of kidney-transplant (KT) patients, with graft failure/loss in approximately 90% of cases. Reducing immunosuppression is the key treatment option, but addition of leflunomide may improve BK Virus (BKV) clearance and graft survival. In a prospective open-labeled study, 12 KT patients with biopsy-proven PVAN were treated with reduced immunosuppression and leflunomide. BKV viremia and graft function were followed. PVAN was diagnosed at 6 months (3-192) post-transplant; median serum creatinine concentration (sCC) was 189 micromol/l (92-265). After 16 months (8-30) of follow-up, the sCC was 150 micromol/l (90-378, NS). Renal function improved in six cases (50%), remained stable in two (16.6%) and deteriorated in four (33.4%), with graft loss in two (17%). Clearance of BKV viremia was observed in five (42%) cases. Side effects included anemia in six cases leading to leflunomide withdrawal in two patients, and mild thrombocytopenia. In KT patients diagnosed with PVAN, leflunomide plus reduced immunosuppression improved graft function in 66.6%, cleared BKV viremia in 42%, and resulted in side effects in 17%. This limited efficacy contrasts with other reports and falls short of expectation. We conclude that active screening, earlier diagnosis and intervention remain the cornerstones of treatment.
Faguer
Stanislas
S
Nephrology, Dialysis, and Multiorgan Transplant Unit, University Hospital, CHU Rangueil, Toulouse, France.
Hirsch
Hans H
HH
Kamar
Nassim
N
Guilbeau-Frugier
Celine
C
Ribes
David
D
Guitard
Joëlle
J
Esposito
Laure
L
Cointault
Olivier
O
Modesto
Anne
A
Lavit
Michel
M
Mengelle
Catherine
C
Rostaing
Lionel
L
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001739:BK Virus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D007555:Isoxazoles / Q000009:adverse effects / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000188:drug therapy* / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D000077339:Leflunomide; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000150:complications / Q000188:drug therapy*; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000150:complications / Q000188:drug therapy*
D000998:Antiviral Agents; D007555:Isoxazoles; D000077339:Leflunomide