Evaluation of fluoroquinolones for the prevention of BK viremia after renal transplantation.
OBJECTIVE
Nearly 30% of renal transplant recipients develops BK viremia, a prerequisite for BK nephropathy. Case reports have evaluated treatment options for BK virus, but no controlled studies have assessed prophylactic therapies. Fluoroquinolone antibiotics were studied for prevention of BK viremia after renal transplantation.


METHODS
This retrospective analysis evaluated adult renal transplant recipients with at least one BK viral load (blood) between 90 and 400 days after transplantation. Six to 12 months of co-trimoxazole was used for Pneumocystis prophylaxis. In sulfa-allergic/-intolerant patients, 6 to 12 months of atovaquone with 1 month of a fluoroquinolone was used. Fluoroquinolones can inhibit BK DNA topoisomerase. The two groups studied were those that received 30 days of levofloxacin or ciprofloxacin after transplantation and those that did not. The primary endpoint was BK viremia rates at 1 year. Of note, of the 160 patients not receiving fluoroquinolone prophylaxis, 40 received a fluoroquinolone for treatment of a bacterial infection within 3 months after transplantation. Subgroup analysis evaluating these 40 patients against the 120 who had no exposure to fluoroquinolones was completed.


RESULTS
A 1-month fluoroquinolone course after transplantation was associated with significantly lower rates of BK viremia at 1 year compared with those with no fluoroquinolone. In the subgroup analysis, exposure to fluoroquinolone for treatment of bacterial infections within 3 months after transplantation was associated with significantly lower 1-year rates of BK viremia.


CONCLUSIONS
This analysis demonstrates that fluoroquinolones are effective at preventing BK viremia after renal transplantation.
Department of Transplant Surgery, Center for for Clinical Investigation, Brigham and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. sgabardi@partners.org
Steven
S
Gabardi
Sushrut S
SS
Waikar
Spencer
S
Martin
Keri
K
Roberts
Jie
J
Chen
Lea
L
Borgi
Hussein
H
Sheashaa
Christine
C
Dyer
Sayeed K
SK
Malek
Stefan G
SG
Tullius
Nidyanandh
N
Vadivel
Monica
M
Grafals
Reza
R
Abdi
Nader
N
Najafian
Edgar
E
Milford
Anil
A
Chandraker
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D001739:BK Virus / Q000472:pathogenicity*; D001900:Boston; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014766:Viremia / Q000517:prevention & control
D000998:Antiviral Agents; D024841:Fluoroquinolones; D007166:Immunosuppressive Agents