title: BK virus nephropathy after simultaneous pancreas-kidney transplantation.
abstract: BACKGROUND
  BK virus nephropathy (BKVN) was reported in up to 7.5% of patients after simultaneous pancreas-kidney transplantation (SPK). Its management by reduction in immunosuppression might pre-dispose to pancreatic graft loss.
  
  
  METHODS
  A retrospective analysis of 178 SPK recipients was performed. All patients received thymoglobulin, daclizumab and a maintenance of low-dose steroids, tacrolimus, and either sirolimus or mycophenolate.
  
  
  RESULTS
  Two (1.1%) patients were identified with BKVN. Time of diagnosis was 22 and 45 months after transplant. Both patients had superimposed calcineurin toxicity in their graft biopsies. Immunosuppression was reduced in both patients, and leflunomide (LEF) was used in one patient. Concurrent kidney rejection episodes were treated with steroid pulses in both patients. One kidney graft improved with a last estimated glomerular filtration rate (GFR) of 43 mL/min, and another kidney graft showed limited improvement with a last GFR of 30 mL/min. Pancreatic graft function remained excellent in both patients as assessed by serum c-peptide, glycosylated hemoglobin, amylase-lipase, and urine amylase levels.
  
  
  CONCLUSIONS
  Low incidence of BKVN was observed in our SPK series. Reduction in immunosuppression and sometimes LEF can be effective. The underlying mechanism of stable pancreatic allograft function despite ongoing kidney rejection warrants further investigation.
authors.affiliation: Division of Transplantation, Departments of Surgery and Pathology, The Lillian Jean Kaplan Renal Transplant Center, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Edip
authors.initials: E
authors.lastname: Akpinar
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.forename: Jun
authors.initials: J
authors.lastname: Sageshima
authors.forename: Linda
authors.initials: L
authors.lastname: Chen
authors.forename: Giselle
authors.initials: G
authors.lastname: Guerra
authors.forename: Warren
authors.initials: W
authors.lastname: Kupin
authors.forename: David
authors.initials: D
authors.lastname: Roth
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: George
authors.initials: G
authors.lastname: Burke
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D001739:BK Virus / Q000472:pathogenicity*; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D027601:Polyomavirus Infections / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D012189:Retrospective Studies; D015996:Survival Rate; D014412:Tumor Virus Infections / Q000188:drug therapy / Q000473:pathology / Q000821:virology*
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents