Leflunomide Treatment in BK Virus Associated Nephropathy after Renal Transplantation

Korean Journal of Nephrology 2009;28(3):211-218.

Young-Ki Son, M.D.1, Joon-Seok Oh, M.D.1, Hyae-Ju Oh, M.D.1, Yong Hun Shin, M.D.1, Joong Kyung Kim, M.D.1 and Hyeon-Joo Jeong, M.D.2

Department of Internal Medicine, Bong Seng Hospital, Busan, Korea1 Department of Pathology²
Yonsei University

임상연구 : 신장이식 후 BK 바이러스 관련 신병증에서의 leflunomide의 임상경험

손영기1, 오준석1, 오혜주1, 신용훈1, 김중경1, 정현주2

김원묵 기념 봉생병원 내과1, 연세대학교의과대학 병리학교실2

Abstract

Purpose:BK virus associated nephropathy (BKVAN) affects 1-10% of kidney transplant (KT) patients and it produces a progressive destruction of allograft. Reducing immunosuppression is the only way to save the graft, while it needs tight monitoring of the graft rejection and graft survival is poorer in advanced case. Leflunomide has immunosuppressive effect and also antiviral activity. Addition of leflunomide may improve BK virus clearance and graft survival. Methods:6 KT patients with biopsy proven BKVAN (Histological pattern B) were treated with leflunomide and reduced immunosuppression. All patients were monitored with serial determination of viral load in blood and graft function. Results:BKVAN was diagnosed at 14 months (7-28) post transplant, at that time median serum creatinine concentration was 2.8 mg/dL (1.8-3.6). 12.5 months (6-16) later of leflunomide treatment, median serum creatinine was 2.3 mg/dL and no graft loss was found. Conclusion:Leflunomide therapy with reduced immunosuppression may be effective in the treatment for BKVAN.

Key Words: BK virus, Kidney transplantation, Leflunomide