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J Nephropathol. 2016;5(1): 34-37.
doi: 10.15171/jnp.2016.06
PMID: 27047808
PMCID: PMC4790185
  Abstract View: 4653
  PDF Download: 2233

Original Article

Evaluation of leflunomide for the treatment of BK viremia and biopsy proven BK nephropathy; a single center experience

Nicole Nesselhauf 1*, Jaclyn Strutt 2, Bahar Bastani 3

1 Department of Pharmacy, SSM Saint Louis University Hospital, Saint Louis, Missouri, USA
2 Department of Pharmacy, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
3 Division of Nephrology, Saint Louis University, School of Medicine, Saint Louis, Missouri, USA
*Corresponding Author: *Corresponding author: Nicole Nesselhauf, SSM Saint Louis University Hospital, 3635 Vista Ave at Grand Blvd. St. Louis, USA. , Email: Nicole.nesselhauf@ssmsluh.com

Abstract

Background: BK virus reactivation is a significant complication following renal transplantation that can result in graft failure. Reduction of immunosuppression and substitution of leflunomide for mycophenolate mofetil (MMF) has been used to treat this entity.

Objectives: To evaluate the use of leflunomide in BK viremia (BKV) and biopsy proven BK nephropathy (BKN) in kidney and kidney-pancreas transplant recipients.

Patients and Methods: We retrospectively reviewed 28 kidney and kidney-pancreas transplant recipients who had received leflunomide for BKV from January 2006 to November 2012. Demographics, time to BKV diagnosis, biopsy findings, rejection episodes, and laboratory data were recorded.

Results: The average (mean ± SD) time to BKV from time of transplant was 316.1 ± 368.0 days (62-1708 days). At time of diagnosis, 64% of patients had their maintenance immunosuppression reduced. The indications for leflunomide administration were; BKV and biopsy proven acute rejection (BPAR) (50%), biopsy proven BKN (18%), or persistent BKV (25%). Therapeutic levels (50-100 mcg/mL) were achieved in only 54% of patients, and 60% of them had required a leflunomide dose of at least 60 mg/day. BK virus was cleared from the serum on average of 151 ± 145.2 days (17-476 days). At study commencement, 29% of patients had remained on leflunomide due to persistent BKV.

Conclusions: In our study, most patients required at least a 60 mg daily dose of leflunomide to achieve therapeutic levels and to clear the virus compared to the standard 40 mg daily dose. Delaying therapy may result in progressive BKV and BKN.


Implication for health policy/practice/research/medical education:

The use of more potent immunosuppressive medications in transplantation has decreased the rate of rejection; however, it has resulted in increased incidence of BK viremia (BKV), BK virus associated nephropathy, and subsequent graft failure. Decreasing total immune suppression and substituting leflunomide for mycophenolate has been used to remedy cases of BK nephropathy (BKN) and BKV with concomitant rejection. We present our experience with the use of leflunomide in such situations.

Please cite this paper as: Nesselhauf N, Strutt J, Bastani B. Evaluation of leflunomide for the treatment of BK viremia and biopsy proven BK nephropathy; a single center experience. J Nephropathol. 2016;5(1):34-37. DOI: 10.15171/jnp.2016.06

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ePublished: 23 Dec 2015
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