FP889LONG TERM FOLLOW UP OF ACTIVE MANAGEMENT VERSUS MINIMIZATION OF IMMUNOSUPPRESSIVES OF BK VIRUS ASSOCIATED NEPHROPATHY AFTER A KIDNEY TRANSPLANT

Abstract

Introduction and Aims: There is no active treatment for post‐renal transplant BK virus associated nephropathy (BKVAN) that has proven to be effective so far. We aimed to assess effectiveness of active management of BKVAN with combined leflunomide, IVIG and ciprofloxacin on the long term graft outcome compared to minimization of immunosuppressives. Methods: Our kidney transplant recipients were screened for BKVAN. Group1 (n=22): was composed of kidney transplant recipients with twice positive BK virus‐PCR in urine and blood who underwent graft biopsy to confirm BKVAN. Once BKVAN is diagnosed, anti‐metabolite (mycophenolate mofetil or azathioprine) was changed to leflunomide and a course of IVIG and oral ciprofloxacin were given. Group 2(n=33): was composed of BKVAN patients treated conventionally with reduced immunosuppressives. Results: Fifty five patients were treated, 69%were males, 50.9% were diabetics, mean HLA mismatches was 3.65 and 50.9% of patients were CW7 negative. All patients received induction therapy (thymoglobulin in 55.6%) and 52.7% received antirejection therapy before BKVAN diagnosis. Maintenance immunosuppression was prednisolone (96.3%), mycophenolate mofetil (94.5%) and tacrolimus (50.9%). Subsequent rejection episodes have occurred in 38% of the patients after BKVAN diagnosis. Basal mean eGFR was 52.5±25.5 which has reduced significantly to 38.1±27.8 ml/min/1.73m2 (p <0.0001) at the end of the study without significant differences between the groups (p 0.08 and 0.17respectively). Follow up period was 7.3±4.99 years. There was no significant difference in the patient outcome. Graft survival was significantly better in group2 (p 0.032). Conclusions: Minimization of immunosuppressive drugs was more effective than actively treating BKVAN with a combination of leflunomide, IVIG and ciprofloxacin regarding long term graft outcome.