title: Efficacy of intravenous immunoglobulin in the treatment of persistent BK viremia and BK virus nephropathy in renal transplant recipients.
abstract: BK virus-associated nephropathy (BKVN) can cause clinically significant viral infection in renal transplant recipients, leading to allograft dysfunction and loss. The usual management of BKVN involves the reduction of immunosuppression and the addition of leflunomide, quinolones, and cidofovir, but the rate of graft loss remains high. The aim of this study was to assess the impact of treatment with intravenous human immunoglobulin (IVIG) on the outcome of BKVN in renal transplant recipients. Upon diagnosis of BKVN, patients remained on anti-polyomavirus treatment, consisting of the reduction of immunosuppression and the use of leflunomide therapy. Treatment with IVIG was given only to patients who did not respond to 8 weeks of the adjustment of immunosuppression and leflunomide. All 30 patients had persistent BKV viremia and BKVN with their mean BK viral loads higher than the baseline (range, 15,000-2 million copies/mL). Mean peak BK load was 205,314 copies/mL compared with 697 copies/mL after 1 year of follow-up. Twenty-seven patients (90%) had a positive response in clearing viremia. The actuarial patient and graft survival rates after 12 months were 100% and 96.7%, respectively. IVIG administration appeared to be safe and effective in treating BKV viremia and BKVN and preventing graft loss in patients who had inadequate response to immunosuppression reduction and leflunomide therapy.
authors.affiliation: American University of Health Sciences, Signal Hill, California, United States; National Institute of Transplantation, Los Angeles, California, United States; Western University of Health Sciences, Pomona, California, United States; Transplant Research Institute, Los Angeles, California, United States; St.Vincent Medical Center, Los Angeles, California, United States.
authors.forename: D
authors.initials: D
authors.lastname: Vu
authors.affiliation: Western University of Health Sciences, Pomona, California, United States; Transplant Research Institute, Los Angeles, California, United States; St.Vincent Medical Center, Los Angeles, California, United States; University of Southern California, Los Angeles, California, United States.
authors.forename: T
authors.initials: T
authors.lastname: Shah
authors.affiliation: Transplant Research Institute, Los Angeles, California, United States.
authors.forename: J
authors.initials: J
authors.lastname: Ansari
authors.affiliation: Transplant Research Institute, Los Angeles, California, United States; St.Vincent Medical Center, Los Angeles, California, United States.
authors.forename: R
authors.initials: R
authors.lastname: Naraghi
authors.affiliation: Western University of Health Sciences, Pomona, California, United States; St.Vincent Medical Center, Los Angeles, California, United States. Electronic address: vud@westernu.edu.
authors.forename: D
authors.initials: D
authors.lastname: Min
mesh_terms: D001739:BK Virus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007668:Kidney / Q000821:virology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000821:virology; D066027:Transplant Recipients; D014412:Tumor Virus Infections / Q000188:drug therapy* / Q000821:virology; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy* / Q000821:virology
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors