Minimizing BK Virus Renal Allograft Loss Through Immunosuppression Regimen Modification
Public Deposited- Last Modified
- February 26, 2019
- Creator
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Meyer, Alyson E.
- Affiliation: Eshelman School of Pharmacy
- Abstract
- Purpose: The primary objective of this study was to examine graft loss rate following institution specific immunosuppression (IS) modulation in the treatment of BK virus re-activation post-renal transplant. Methods: A retrospective chart analysis identified 212 patients over 18 years of age receiving a single renal allograft at UNC Hospitals between 2005 and 2013 with reactivated BK virus as confirmed by the presence of decoy cells on urine cytology through follow-up until August 2014. Results: Of the 212 renal allografts with reactivated BK, 33 (15.6%) had progressed to BKVAN (BK virus-associated nephropathy). Renal biopsy identified 15 patients with Stage A BKVAN, 16 with Stage B and 2 with Stage C. IS regimen changes included reduction in tacrolimus trough goals (60.6%), reduction in mycophenolic acid (24.2%), discontinuation of mycophenolic acid (81.8%), the addition of leflunomide (57.5%) or azathioprine (18%) and re-initiation of corticosteroids (65%). IS changes preserved graft function in 97% of patients, with only one graft lost (3%) following confirmed diagnosis with BKVAN. Conclusion: UNC Hospitals reports a graft loss rate of only 3% among all diagnosed stages of BKVN. In contrast to current guidelines, UNC follows a protocol with more aggressive screening, a lower threshold for acquiring blood PCRs and IS adjustment, along with the addition of leflunomide and prednisone therapy.
- Date of publication
- spring 2016
- Keyword
- DOI
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- Rights statement
- In Copyright
- Note
- Funding: None
- Advisor
- Dupuis, Robert
- Degree
- Doctor of Pharmacy
- Honors level
- Highest Honors
- Degree granting institution
- University of North Carolina at Chapel Hill
- Extent
- 11
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