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:
- Withdrawal of MMF or tacrolimus
- Replacement of tacrolimus by cyclosporine
- Overall reduction of immunosuppressive load
- 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
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