BK Virus - Treatment

Treatment

The cornerstone of therapy is reduction in immunosuppression. A recent surge in BKVN correlates with use of potent immunosuppressant drugs, such as tacrolimus and mycophenolate mofetil (MMF). Studies have not shown any correlation between BKVN and a single immunosuppressive agent but rather the overall immunosuppressive load.

  • No guidelines or drug levels and doses exist for proper reduction of immunosuppressants in BKVN
  • Most common methods:
  1. Withdrawal of MMF or tacrolimus
  2. Replacement of tacrolimus by cyclosporine
  3. Overall reduction of immunosuppressive load
  4. Some cyclosporine trough levels reported to be reduced to 100–150 ng/ml and tacrolimus levels reduced to 3–5 ng/ml
  • Retrospective analysis of 67 patients concluded graft survival was similar between reduction and discontinuation of agents.
  • Single center study showed renal allografts were preserved in 8/8 individuals managed with reduction in immunosuppression while graft loss occurred in 8/12 patients treated with an increase in therapy for what was thought to be organ rejection.

Other therapeutic options include Leflunomide, Cidofovir, IVIG, and the fluoroquinolones. Leflunomide is now generally accepted as the second treatment option behind reduction of immunosuppression.

Read more about this topic:  BK Virus

Famous quotes containing the word treatment:

    “If the study of all these sciences, which we have enumerated, should ever bring us to their mutual association and relationship, and teach us the nature of the ties which bind them together, I believe that the diligent treatment of them will forward the objects which we have in view, and that the labor, which otherwise would be fruitless, will be well bestowed.”
    —Plato (c. 427–347 B.C.)

    “Any important disease whose causality is murky, and for which treatment is ineffectual, tends to be awash in significance.”
    —Susan Sontag (b. 1933)

    “A regular council was held with the Indians, who had come in on their ponies, and speeches were made on both sides through an interpreter, quite in the described mode,—the Indians, as usual, having the advantage in point of truth and earnestness, and therefore of eloquence. The most prominent chief was named Little Crow. They were quite dissatisfied with the white man’s treatment of them, and probably have reason to be so.”
    —Henry David Thoreau (1817–1862)