Intermediate dose cidofovir does not cause additive nephrotoxicity in BK virus allograft nephropathy.
BKVAN has emerged as a major morbidity in kidney transplant recipients. Among treatment options is cidofovir, which can be nephrotoxic. We previously reported that intermediate dose cidofovir could be used without significant nephrotoxicity. We present extended results of the same treatment protocol in a larger cohort and with longer follow up. Diagnosis of BKVAN was based on detection of BK viral DNA from plasma and renal allograft biopsy tissue. All patients received cidofovir (0.25-1 mg/kg/dose) every 2-3 wk. Total number of cidofovir doses ranged from 1 to 18 (mean 8). This report includes eight patients, aged 5-21 yr, treated with intermediate dose cidofovir. Median follow-up was 11 months (range 4-32). Mean fall in reciprocal of serum creatinine (1/sCr) from baseline at BKVAN diagnosis was 64% (range 28-120%). A time-series plot of plasma BK virus PCR and 1/sCr showed marked reduction in viral loads without significant deterioration in 1/sCr from the initial value at BKVAN diagnosis. In this larger series with extended follow up, intermediate dose cidofovir without probenecid for the treatment of BKVAN continues to show stabilization of renal function without progression to renal failure.
Divisions of Pediatric Nephrology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA. arayace@peds.ufl.edu
Carlos E
CE
Araya
Judy F
JF
Lew
Robert S
RS
Fennell
Richard E
RE
Neiberger
Vikas R
VR
Dharnidharka
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D001739:BK Virus / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D000077404:Cidofovir; D015331:Cohort Studies; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy* / Q000821:virology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D063065:Organophosphonates / Q000008:administration & dosage*; D012189:Retrospective Studies
D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir