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Everolimus-based immunosuppression therapy for BK virus nephropathy.
N Polanco1, E González Monte1, M D Folgueira2
1Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain.
Transplantation Proceedings
|February 4, 2015
Summary
Switching to everolimus (EVE) therapy improved kidney function and reduced BK virus nephropathy (BKN) in transplant patients. This mTOR inhibitor strategy effectively lowered viral load and prevented rejection, enhancing graft survival.
Area of Science:
- Nephrology
- Transplantation Immunology
- Virology
Background:
- Mammalian target of rapamycin inhibitors (mTOR-i) show antiviral properties, making them potential treatments for BK virus nephropathy (BKN).
- A protocol was established in 2007 to convert BKN patients from calcineurin inhibitors to everolimus (EVE)-based therapy, avoiding calcineurin inhibitors.
Purpose of the Study:
- To evaluate the efficacy of converting immunosuppressive therapy to everolimus (EVE) in patients diagnosed with BK virus nephropathy (BKN).
Main Methods:
- A prospective, single-center case series involved 15 BKN patients diagnosed between 2007 and 2010.
- Nine patients underwent immunosuppression modification, including mycophenolate suspension and conversion from tacrolimus to EVE.
Main Results:
- All patients showed positive renal function evolution post-conversion, with mean serum creatinine (sCr) improving from 1.85 mg/dL at diagnosis to 1.6 mg/dL at follow-up (P = .05).
- BK viremia resolved in 5 patients and decreased by over 95% in 4 others.
- No acute rejection episodes occurred after switching immunosuppressants.
Conclusions:
- Conversion to an mTOR inhibitor-based regimen offers benefits for BKN patients.
- This strategy effectively reduces BK viremia and may improve graft survival in selected kidney transplant recipients.
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