Therapy with mTOR Inhibitors in Polyomavirus Allograft Nephropathy (PVAN): A Five Year Follow Up

Guanaes Bonini Ana Theresa,Lf Camargo,Cf Do Valle,Gg Rivelli,Mv De Sousa,M Mazzali,Ab Albuquerque Esteves

doi:10.17352/2640-7973.000003

Abstract

Polyomavirus nephropathy (PVAN) has a negative impact on renal allograft survival. Therapy options include reduction of immunosuppression and antiviral drugs.

Highlights

Polyomavirus allograft nephropathy (PVAN) is an important post-transplant complication
In Polyomavirus infected tubular cells culture, sirolimus and/or leflunomide reduced the expression of BKvirus large T antigen, suppressing the infection [3]
Routine screening of Polyomavirus: all renal transplant recipients have a sequential viruria screening, in a regular interval within first 3 years posttransplant is classified according to Banff criteria [4]

Summary

Introduction

Polyomavirus allograft nephropathy (PVAN) is an important post-transplant complication. Despiteits low incidence, around 5%, graft loss occurs in about 50% of cases [1]. In established PVAN (stage B), reduction in immunosuppressive therapy is considered as a safe strategy, in order to retard graft loss. While some groups suggest reduction of mycophenolate doses, others consider calcineurin inhibitors withdrawal or converting therapy to mTOR inhibitors or azathioprine [2]. Experimental data showed that Polyomavirus activates mTOR pathway in epithelial tubular cells. In Polyomavirus infected tubular cells culture, sirolimus and/or leflunomide reduced the expression of BKvirus large T antigen, suppressing the infection [3]

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Conclusion