Abstract
Background. BK virus (BKV) infection is a common complication following kidney transplantation. Immunosuppression reduction is the cornerstone of treatment while adjuvant drugs have been tried in small uncontrolled studies. We sought to examine our center's experience with the use of ciprofloxacin in patients with persistent BKV infection. Methods. Retrospective evaluation of the effect of a 30-day ciprofloxacin course (250 mg twice daily) on BKV infection in kidney transplant recipients who had been diagnosed with BK viruria ≥106 copies/mL and viremia ≥500 copies/mL and in whom the infection did not resolve after immunosuppression reduction and/or treatment with other adjuvant agents. BKV in plasma and urine was evaluated after 3 months following treatment with ciprofloxacin. Results. Nine kidney transplant recipients received ciprofloxacin at a median of 130 days following the initial reduction in immunosuppression. Three patients showed complete viral clearance and another 3 had a ≥50% decrease in plasma viral load. No serious adverse events secondary to ciprofloxacin were reported and no grafts were lost due to BKV up to 1 year after treatment. Conclusion. Ciprofloxacin may be a useful therapy for persistent BKV infection despite conventional treatment. Randomized trials are required to evaluate the potential benefit of this adjuvant therapy.
Highlights
BK polyomavirus (BKV) is a common pathogen of kidney transplant recipients, which can result in impaired graft function and inferior graft survival [1]
Retrospective evaluation of the effect of a 30-day ciprofloxacin course (250 mg twice daily) on BK virus (BKV) infection in kidney transplant recipients who had been diagnosed with BK viruria ≥106 copies/mL and viremia ≥500 copies/mL and in whom the infection did not resolve after immunosuppression reduction and/or treatment with other adjuvant agents
BKV infection continues to have a major impact on graft function with nearly 25% of infected patients showing a sustained increase in serum creatinine of at least 50% compared to that observed at the time of diagnosis [6]
Summary
BK polyomavirus (BKV) is a common pathogen of kidney transplant recipients, which can result in impaired graft function and inferior graft survival [1]. The inability to clear this virus despite a reduction in immunosuppression has led to a variety of additional agents with possible anti-BK activity being utilized as adjuvant therapy including leflunomide, cidofovir, and intravenous immunoglobulin (IVIG) [10]. All of these agents have been reported to be beneficial in anecdotal cases. Retrospective evaluation of the effect of a 30-day ciprofloxacin course (250 mg twice daily) on BKV infection in kidney transplant recipients who had been diagnosed with BK viruria ≥106 copies/mL and viremia ≥500 copies/mL and in whom the infection did not resolve after immunosuppression reduction and/or treatment with other adjuvant agents. Randomized trials are required to evaluate the potential benefit of this adjuvant therapy
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