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Low-dose cidofovir and conversion to mTOR-based immunosuppression in polyomavirus-associated nephropathy
- Source :
- Transpl. Infect. Di., DOI: 10.1111/tid.13228 (2020)
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
Abstract
- Background: Polyomavirus-associated nephropathy (PVAN) remains a relevant complication following kidney transplantation with allograft loss rates of up to 50%. Reduction in overall immunosuppression is a cornerstone of therapy, whereas no specific antiviral regimen has shown conclusive benefit to date. The present case series demonstrates the efficacy of a dual therapeutic approach with low-dose cidofovir and conversion to mTOR-based immunosuppression in PVAN. Methods: Patients with biopsy-proven PVAN having received low-dose cidofovir (0.25mg/kg) according to the Tübingen Cidofovir Protocol and been converted to mTOR-based immunosuppression were analyzed retrospectively. Results: Twenty-three patients with a median follow-up of 2.24 [IQR 1.55-5.01] years were included in the analysis. Median time to PVAN diagnosis was 268 [IQR 153-869] days after transplantation. Polyomavirus clearance from plasma was achieved in 78% of patients after a median of 118 [IQR 76-293] days. Of the 23 patients, nine patients (39%) lost their allograft function during follow-up, but only three of these (13%) due to PVAN. Fourteen patients (61%) stabilized or improved allograft function. The cidofovir protocol allowed for specific antiviral therapy without adverse nephrotoxicity, even in patients with low allograft function. Conclusions: Low-dose cidofovir and conversion to mTOR-based immunosuppression allow for effective virus clearance and preservation of allograft function in a high proportion of patients with PVAN and progressive allograft dysfunction and may prolong allograft survival in these patients.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Biopsy
Urology
030230 surgery
Kidney
Antiviral Agents
Nephropathy
Nephrotoxicity
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
medicine
Humans
Kidney transplantation
Retrospective Studies
Bkv
Cidofovir
Mtor
Polyoma
Polyomavirus-associated Nephropathy
Renal Transplantation
Immunosuppression Therapy
Transplantation
Polyomavirus Infections
business.industry
TOR Serine-Threonine Kinases
Immunosuppression
Middle Aged
medicine.disease
Kidney Transplantation
Regimen
Tumor Virus Infections
Infectious Diseases
chemistry
030211 gastroenterology & hepatology
Kidney Diseases
Complication
business
Polyomavirus
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Transpl. Infect. Di., DOI: 10.1111/tid.13228 (2020)
- Accession number :
- edsair.doi.dedup.....a83c182de9d557be3234bcff1bd3f131