Dr SHABANA KALLA1, Dr BRIAN DOUCET1,2, LORRAINE GARRY1, Dr GEORGE JOHN1,2
1Royal Brisbane and Women’s Hospital, Brisbane , Australia, 2School of Clinical Medicine, The University of Queensland, Brisbane, Australia
Aim: BK virus infection is an increasingly common clinical challenge encountered in kidney transplantation. The current universally accepted management approach is reduction of immunosuppression. We present our local experience in managing BK infection with leflunomide, a pyrimidine synthase inhibitor, when initial reduction of immunosuppression is unsuccessful.
Methods: This study includes kidney transplant recipients managed through the Kidney Health Services at the Royal Brisbane and Women’s Hospital as of September 2021. All patients with detectable serum BK virus DNA were included. BK titres at the time of diagnosis and transplant kidney biopsy results were collected. Clinical and pharmacy dispensary records were reviewed to identify patients treated with leflunomide. Outcomes were collected for leflunomide treated patients including suppression of BK titres to below detectable levels, persistent reduction in titres, or graft loss.
Results: Of the 241 kidney transplant recipients reviewed; 32 patients (13%) had a positive serum BK result. BK titre at diagnosis ranged from 13 to 160,000 copies/mL. Transplant kidney biopsy was performed on 12 patients (38%) with BK viraemia with 6 renal biopsies (19%) demonstrating concurrent BK nephropathy. 11 BK-positive patients (34%) received leflunomide of which 4 (36%) had BK titres persistently reduced to ≤ 350 copies/mL. 5 leflunomide treated patients (45%) achieved BK titres below undetectable levels and graft loss from BK nephropathy occurred in 2 leflunomide treated patients (18%).
Conclusions: Leflunomide may promote the suppression of BK viraemia in kidney transplant recipients with BK virus infection unresponsive to initial reduction of immunosuppression.
Biography:
Dr Kalla is a first year Advanced Trainee in Nephrology at the Royal Brisbane and Women’s Hospital. Her areas of interests include Kidney Transplantation and Kidney supportive care.