title: Active management versus minimization of immunosuppressives of BK virus-associated nephropathy after a kidney transplant.
abstract: OBJECTIVE
  Thus far, there is no active treatment for BK virus-associated nephropathy after a kidney transplant that has proven to be effective. We sought to assess the effectiveness of treatment with leflunomide, intravenous immunoglobulin, and ciprofloxacin on graft outcome after 1 year compared with a historical group treated with reduced immunosuppressive medications strategy.
  
  
  METHODS
  Group 1 (n = 19) was composed of kidney transplant recipients with twice positive BK virus-polymerase chain reaction in urine and blood who underwent graft biopsy to confirm BK virus-associated nephropathy. Once BK virus-associated nephropathy was diagnosed, antimetabolite (mycophenolate mofetil or azathioprine) was changed to leflunomide, and intravenous immunoglobulin and oral ciprofloxacin were given. Group 2 (n = 14) was composed of BK virus-associated nephropathy patients treated conventionally with reduced immunosuppressive medications.
  
  
  RESULTS
  Thirty-three patients were treated, 23 were males (70%), there were 15 were deceased donors (45.5%), 15 were diabetics (45.5%), mean human leukocyte antigen mismatches were 3.76, seven had a zero DR mismatch (21.2%), and 8 were CW7 negative (24.2%). All patients received induction therapy (thymoglobulin in 22 [66.6%]), 7 had delayed graft function (21.2%) and 18 received antirejection therapy before receiving BK virusassociated nephropathy diagnosis (52.9%). Maintenance immunosuppression was prednisolone and mycophenolate mofetil (2 g/d) in 31 patients (94%), and tacrolimus in 13 (39.4%). Tacrolimus was given to 12 patients in group 1 (63.1%), while sirolimus was given to 7 patients in group 2 (50%). One graft was lost in each group by the end of the study, and 1 patient died with functioning graft in group 2.
  
  
  CONCLUSIONS
  No significant difference existed in 1-year graft outcomes between treatment of BK virus-associated nephropathy by reduction of immunosuppressive medications or actively by leflunomide, intravenous immunoglobulin, and ciprofloxacin.
authors.affiliation: From the Hamed Al-Essa Organ Transplantation Centre, Ibn Sina Hospital, Safat, Kuwait.
authors.forename: Medhat Abdel
authors.initials: MA
authors.lastname: Halim
authors.forename: Torki
authors.initials: T
authors.lastname: Al-Otaibi
authors.forename: Osama
authors.initials: O
authors.lastname: Gheith
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Zkaria
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mosaad
authors.forename: Tarek
authors.initials: T
authors.lastname: Said
authors.forename: Prasad
authors.initials: P
authors.lastname: Nair
authors.forename: Narayanan
authors.initials: N
authors.lastname: Nampoory
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D001739:BK Virus / Q000187:drug effects* / Q000276:immunology / Q000472:pathogenicity; D001706:Biopsy; D002939:Ciprofloxacin / Q000008:administration & dosage*; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007555:Isoxazoles / Q000008:administration & dosage*; D007668:Kidney / Q000187:drug effects* / Q000276:immunology / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects*; D000077339:Leflunomide; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D002939:Ciprofloxacin; D000077339:Leflunomide