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Mühlbacher, T. ; Beck, R.* ; Nadalin, S.* ; Heyne, N. ; Guthoff, M.

Low-dose cidofovir and conversion to mTOR-based immunosuppression in polyomavirus-associated nephropathy.

Transpl. Infect. Di., DOI: 10.1111/tid.13228 (2020)
Postprint DOI PMC
Open Access Green
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 (0.25 mg/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.
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Publikationstyp Artikel: Journalartikel
Dokumenttyp Wissenschaftlicher Artikel
Korrespondenzautor
Schlagwörter Bkv ; Cidofovir ; Mtor ; Polyoma ; Polyomavirus-associated Nephropathy ; Renal Transplantation; Bk Virus Nephritis; Interstitial Nephritis; Mycophenolic-acid; Single-center; Replication; Everolimus; Leflunomide; Therapy; Risk
ISSN (print) / ISBN 1398-2273
e-ISSN 1399-3062
Zeitschrift Transplant infectious disease
Verlag Wiley
Verlagsort Hoboken, NJ.
Nichtpatentliteratur Publikationen
Begutachtungsstatus Peer reviewed
Institut(e) Institute of Diabetes Research and Metabolic Diseases (IDM)