%0 Journal Article
%T Adjuvant Ciprofloxacin for Persistent BK Polyomavirus Infection in Kidney Transplant Recipients
%A David Arroyo
%A Sindhu Chandran
%A Parsia A. Vagefi
%A David Wojciechowski
%J Journal of Transplantation
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/107459
%X Background. BK virus (BKV) infection is a common complication following kidney transplantation. Immunosuppression reduction is the cornerstone of treatment while adjuvant drugs have been tried in small uncontrolled studies. We sought to examine our center¡¯s experience with the use of ciprofloxacin in patients with persistent BKV infection. Methods. Retrospective evaluation of the effect of a 30-day ciprofloxacin course (250£¿mg twice daily) on BKV infection in kidney transplant recipients who had been diagnosed with BK viruria ¡Ý106 copies/mL and viremia ¡Ý500 copies/mL and in whom the infection did not resolve after immunosuppression reduction and/or treatment with other adjuvant agents. BKV in plasma and urine was evaluated after 3 months following treatment with ciprofloxacin. Results. Nine kidney transplant recipients received ciprofloxacin at a median of 130 days following the initial reduction in immunosuppression. Three patients showed complete viral clearance and another 3 had a ¡Ý50% decrease in plasma viral load. No serious adverse events secondary to ciprofloxacin were reported and no grafts were lost due to BKV up to 1 year after treatment. Conclusion. Ciprofloxacin may be a useful therapy for persistent BKV infection despite conventional treatment. Randomized trials are required to evaluate the potential benefit of this adjuvant therapy. 1. Introduction BK polyomavirus (BKV) is a common pathogen of kidney transplant recipients, which can result in impaired graft function and inferior graft survival [1]. Approximately 30%, 11¨C13%, and 8% of kidney transplant recipients develop BK viruria, viremia, and BK virus associated nephropathy (BKVAN), respectively [1¨C3]. Graft loss rates have been reported to be as high as 30¨C50% following a diagnosis of BKVAN [1, 4], although more recent data indicate that with early diagnosis of BK viremia or viruria using regular screening, the majority of patients respond favorably [5]. However, BKV infection continues to have a major impact on graft function with nearly 25% of infected patients showing a sustained increase in serum creatinine of at least 50% compared to that observed at the time of diagnosis [6]. Several donor and recipient risk factors for the development of BKV infection have been identified and of these, a high burden of immunosuppression appears to be the most important [7]. A strategy of immunosuppression reduction is therefore considered the cornerstone of treatment for BKV infection [8], although a uniform standardized protocol has not yet been established [2, 9]. The inability to clear this
%U http://www.hindawi.com/journals/jtrans/2014/107459/