title: Leflunomide therapy for BK virus allograft nephropathy after pediatric kidney transplantation.
abstract: The BK virus (BKV) can be reactivated with immunosuppressive treatment in renal allograft recipients, which can result in interstitial nephritis (BKV-associated nephropathy, BKVAN) and lead to renal allograft failure. Recently, leflunomide has been reported in some case series of BKVAN with favorable results. Most studies have included only adult patients, we herein report a pediatric case and include a literature review. The patient was a nine-yr-old female with end-stage renal disease due to hypoxic kidney injury. A deceased donor renal transplant was performed and good initial allograft function was achieved following treatment with prednisolone, tacrolimus and mycophenolate mofetil. The serum Cr level increased to 1.6 mg/dL over the following four-month period. A kidney biopsy revealed pathologic findings of acute cellular rejection and BK nephropathy. After methylprednisolone pulse therapy was administered to control acute rejection, the tacrolimus dose was reduced, and intravenous immunoglobulin treatment and leflunomide therapy were administered to control the BKVAN. Over the following 18 months, the viral load steadily decreased and remained below 100 copies/mL in the plasma. Leflunomide therapy in addition to a reduction of the immunosuppressive therapies resulted in a significant decline in the BK viral load without further deterioration of renal function.
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young H
authors.initials: YH
authors.lastname: Jung
authors.forename: Kyung C
authors.initials: KC
authors.lastname: Moon
authors.forename: Jong W
authors.initials: JW
authors.lastname: Ha
authors.forename: Sang-Joon
authors.initials: SJ
authors.lastname: Kim
authors.forename: Il-Soo
authors.initials: IS
authors.lastname: Ha
authors.forename: Hae I
authors.initials: HI
authors.lastname: Cheong
authors.forename: Hee G
authors.initials: HG
authors.lastname: Kang
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D001739:BK Virus; D002648:Child; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D016030:Kidney Transplantation; D000077339:Leflunomide; D027601:Polyomavirus Infections / Q000188:drug therapy* / Q000209:etiology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000821:virology; D014412:Tumor Virus Infections / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000998:Antiviral Agents; D007555:Isoxazoles; D000077339:Leflunomide