Behandlung der Polyomavirus Nephritis nach Nierentransplantation mit Cidofovir
The polyomavirus-associated nephropathy (PVAN) affects up to 10 % of kidney transplant patients and involves a 50 % risk of transplant failure. No consensus guideline exists how to treat the PVAN. Cidofovir (CV) has long been proposed but it has an unknown antiviral effect in PVAN. 7 Patients with biopsy proven PVAN 5 month to 2 years after kidney transplantation were observed. All Patients received different immunosuppressive drugs; Six of the 7 patients were treated with low dose CV(1.0 - 0.25 mg/kg)without probenecid. One of the 7 patients was treated with reduced immunosuppressive regimen alone and switched from tacrolimus to everolimus (EVR). The serum creatinine (sCR) was taken as measure of the transplant function; the blood viral load was measured for treatment monitoring. In 4 of the 6 CV treated patients the quantified viral load decreased in serum. In one of the other patients polyoma virus completely disappeared in urine and one CV patient had a negative control biopsy. In the last patient with reduction of immunosuppression alone and switching to EVR the viral load decreased without rejection. The mean sCR increased after CV treatment and repetitive transplant biopsy disclosed signs of nephrotoxicity in three cases. Three patients lost their transplant function, but in four cases the transplant function could be preserved. Two of the CV treated patients had signs of myelotoxicity. Two of the patients had an increase of the viral load after termination of the CV treatment; after reduction of immunosuppression, they had a beneficial outcome. CV has a clear antiviral effect but CV use is associated with the risk of nephrotoxicity. Withholding probenecid might increase the risk of myelotoxicity. Future patients could benefit from even lower dose CV with concurrent reduction of immunosuppression.
Subject HeadingsImmunsuppression [GND]
Kidney transplantation [MeSH]