Optimization of the treatment of polyomaviruse infection in patients after kidney transplantation

Abstract

Immunosuppressive therapy is considered to be one of the main risk factors for replication of BK and JC polyomaviruses after kidney transplantation. The effective treatment regimens for dysfunction of the kidney transplantation have been studied in patients with chronic kidney disease V stage with polyomavirus infection. 97 patients with transplanted kidneys during the first year after transplantation were examined. The frequency of detection of BK and JC viruria, JC viruria and viremia was 5 (16.13 %). The frequency of BK viruria was 10 (32.26 %), isolated JC viruria – 2 (6.45 %) and ВК viruria – 1 (3.23 %), simultaneous detection of the JC і ВК viruses was observed in 3 (9.68 %). There are 12 patients with persistant ВК viruria and viremia who need to change immunosuppressive therapy. The median time to detection of persistant BK-viruria and viremia after transplantation in patients with tacrolimus was (12.29±7.16) weeks, in patients with cyclosporine was (12.29±7.16) weeks. The period for elimination of polyomavirus in patients with cyclosporine and mycophenolates included (13.00±5.13) weeks, and in patients with cyclosporine and everolimus included (7.00±2.58) weeks. This investigation revealed different patterns of the treatment of kidney transplant dysfunction caused by BK-polyomavirus infection. The first step in the treatment of BKV infection is reduction in immunosuppression. In this study, we did conversion from tacrolimus to cyclosporine or conversion from mycophenolates to everolimus with restriction of cyclosporine doses. The last strategy showed better results because period for elimination of polyomavirus was shorter.