Volume 7 Issue 1
Jan.  2016
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Fan Yu, Li Jigang, Qian Yeyong, et al. Experience with the application of leflunomide in rescuing therapy of BK virus nephropathy after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant: report of 4 cases[J]. ORGAN TRANSPLANTATION, 2016, 7(1): 48-52,71. doi: 10.3969/j.issn.1674-7445.2016.01.009
Citation: Fan Yu, Li Jigang, Qian Yeyong, et al. Experience with the application of leflunomide in rescuing therapy of BK virus nephropathy after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant: report of 4 cases[J]. ORGAN TRANSPLANTATION, 2016, 7(1): 48-52,71. doi: 10.3969/j.issn.1674-7445.2016.01.009

Experience with the application of leflunomide in rescuing therapy of BK virus nephropathy after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant: report of 4 cases

doi: 10.3969/j.issn.1674-7445.2016.01.009
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  • Corresponding author: Qian Yeyong, Email: qianyy@medmail.com.cn
  • Received Date: 2015-09-08
    Available Online: 2021-01-19
  • Publish Date: 2016-01-15
  •   Objective  To explore the clinical application experience of leflunomide in rescuing therapy of BK virus nephropathy (BKVN) after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant.   Methods  Four recipients with BKVN after renal transplantation were diagnosed at 135th-737th day after operation, with the pathological staging as following: 2 cases in stage A1, 1 case in stage B1 and 1 case in stage B2. For all recipients, leflunomide was used for rescuing therapy due to ineffective treatment with reduction of immunosuppressant for 0.5-3.0 months. Initially, 50 mg/d of leflunomide was given continuously for 3 days, so as to reach therapeutic serum concentration, and then 20 mg/d of leflunomide was given for maintaining. The efficacy and safety were observed.   Results  After a follow-up for an average of 6 months (5-7 months), 3 recipients with development of BKVN were controlled effectively, 1 recipient (stage B2) with ineffective treatment. No obvious adverse reactions occurred during medication.   Conclusions  It is possible to slow down the development of BKVN and reduce the incidence of renal allograft loss by using leflunomide to conduct rescuing therapy of BKVN after renal transplantation in the case of ineffective treatment with reduction of immunosuppressant. Better effect can be achieved if early detection and diagnosis of BKVN are conducted as well as effective measures are taken timely in the early pathological stage.

     

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  • [1]
    Schaub S, Hirsch HH, Dickenmann M, et al. Reducing immunosuppression preserves allograft function in presumptive and definitive polyomavirus-associated nephropathy[J]. Am J Transplant,2010,10(12): 2615-2623. doi: 10.1111/ajt.2010.10.issue-12
    [2]
    Wu JK, Harris MT. Use of leflunomide in the treatment of polyomavirus BK-associated nephropathy[J].Ann Pharmacother,2008,42(11):1679-1685. doi: 10.1345/aph.1L180
    [3]
    解俊杰,钱叶勇,石炳毅,等. 肾移植后BK病毒感染者实时荧光定量PCR检测[J]. 中国组织工程研究,2012,16(5):797-800. http://www.cnki.com.cn/Article/CJFDTOTAL-XDKF201205015.htm

    Xie JJ, Qian YY, Shi BY, et al. BK virus infection detected by real-time fluorescent quantitative PCR method after renal transplantation[J].Chin J Tissue Eng Res, 2012,16(5):797-800. http://www.cnki.com.cn/Article/CJFDTOTAL-XDKF201205015.htm
    [4]
    Kim H, Yang WS, Han DJ, et al. Clinical courses of renal transplant recipients with high BK viremia[J]. Transplant Proc, 2013, 45(8):2975-2979. doi: 10.1016/j.transproceed.2013.08.033
    [5]
    Hirsch HH, Knowles W, Dickenmann M, et al. Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients[J]. N Engl J Med,2002,347(7): 488-496. doi: 10.1056/NEJMoa020439
    [6]
    Geddes CC, Gunson R, Mazonakis E, et al. BK viremia surveillance after kidney transplant: single-center experience during a change from cyclosporine-to lower-dose tacrolimus-based primary immunosuppression regimen[J]. Transpl Infect Dis,2011,13(2): 109-116. doi: 10.1111/tid.2011.13.issue-2
    [7]
    Hirsch HH, Randhawa P, AST Infectious Diseases Community of Practice. BK polyomavirus in solid organ transplantation[J]. Am J Transplant,2013, 13(Suppl 4):179-188. http://cn.bing.com/academic/profile?id=1788698477&encoded=0&v=paper_preview&mkt=zh-cn
    [8]
    Alméras C, Vetromile F, Garrigue V, et al. Monthly screening for BK viremia is an effective strategy to prevent BK virus nephropathy in renal transplant recipients[J]. Transpl Infect Dis,2011,13(2): 101-108. doi: 10.1111/tid.2011.13.issue-2
    [9]
    Gonzalez S, Escobar-Serna DP, Suarez O, et al. BK virus nephropathy in kidney transplantation: an approach proposal and update on risk factors, diagnosis, and treatment[J]. Transplant Proc,2015, 47(6):1777-1785. doi: 10.1016/j.transproceed.2015.05.010
    [10]
    Schachtner T, Stein M, Sefrin A, et al. Inflammatory activation and recovering BKV-specific immunity correlate with self-limited BKV replication after renal transplantation[J]. Transpl Int,2014, 27(3):290-301. doi: 10.1111/tri.2014.27.issue-3
    [11]
    邓伟明,苗芸. 肾移植术后BK病毒相关性肾病的临床诊治研究进展[J]. 器官移植,2015,6(2):120-123,130. http://www.organtranspl.com/browse/detail/qkid/71/id/101.html

    Deng WM, Miao Y. Clinical research progress on diagnosis and treatment of BK virus-associated nephropathy after renal transplantation[J]. Organ Transplant,2015,6(2):120-123,130. http://www.organtranspl.com/browse/detail/qkid/71/id/101.html
    [12]
    Halim MA, Al-Otaibi T, Gheith O, et al. Active management versus minimization of immunosuppressives of BK virus-associated nephropathy after a kidney transplant[J]. Exp Clin Transplant,2014,12(6):528-533. http://cn.bing.com/academic/profile?id=2337090942&encoded=0&v=paper_preview&mkt=zh-cn
    [13]
    解俊杰,钱叶勇,石炳毅,等. 抢救性治疗对肾移植后BK病毒感染及其相关性肾病的临床效果[J]. 中华器官移植杂志,2013,34(2):105-109.

    Xie JJ, Qian YY, Shi BY, et al. Clinical observation of BK viremia and BK virus-associated nephropathy with rescuing therapy in renal transplant recipients[J]. Chin J Organ Transplant, 2013,34(2):105-109.
    [14]
    Andrei G, Snoeck R, Vandeputte M, et al. Activities of various compounds against murine and primate polyomaviruses[J]. Antimicrob Agents Chemother, 1997,41(3):587-593. http://cn.bing.com/academic/profile?id=2107610513&encoded=0&v=paper_preview&mkt=zh-cn
    [15]
    Zavos, G, Gazouli M, Psimenouet E, et al. Polyomavirus BK infection in Greek renal transplant recipients[J]. Transplant Proc, 2004,36(5): 1413-1414. doi: 10.1016/j.transproceed.2004.04.077
    [16]
    Kuypers DR. Management of polyomavirus-associated nephropathy in renal transplant recipients [J]. Nat Rev Nephrol,2012,8(7):390-402. doi: 10.1038/nrneph.2012.64
    [17]
    Hüttemann M, Shipkova M, Klett C, et al. Total and free plasma concentrations of the active metabolite of leflunomide in relation to therapeutic outcome in kidney transplant recipients with BK-virus nephropathy[J]. Transplant Proc,2013,45(4):1611-1613. doi: 10.1016/j.transproceed.2012.12.017
    [18]
    Zaman RA, Ettenger RB, Cheam H, et al. A novel treatment regimen for BK viremia[J]. Transplantation, 2014, 97(11):1166-1171. doi: 10.1097/01.TP.0000441825.72639.4f
    [19]
    Prince O, Savic S, Dickenmann M, et al. Risk factors for polyoma virus nephropathy[J]. Nephrol Dial Transplant,2009, 24(3):1024-1033. http://cn.bing.com/academic/profile?id=2002760966&encoded=0&v=paper_preview&mkt=zh-cn
    [20]
    Schachtner T, Babel N, Reinke P. Different risk factor profiles distinguish early-onset from late-onset BKV-replication[J]. Transpl Int, 2015, 28(9):1081-1091. doi: 10.1111/tri.2015.28.issue-9
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