Abstract: PO2107
A Case of Native BK Virus Nephropathy in a Lung Transplant Patient
Session Information
- Transplantation: Clinical - Allocation, Evaluation, Prognosis, and Viral Onslaughts
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Albasha, Waseem, The University of Arizona College of Medicine Tucson, Tucson, Arizona, United States
- Vahdani, Golnaz, The University of Arizona College of Medicine Tucson, Tucson, Arizona, United States
- Ashoka, Ankita, The University of Arizona College of Medicine Tucson, Tucson, Arizona, United States
- Bracamonte, Erika R., The University of Arizona College of Medicine Tucson, Tucson, Arizona, United States
- Yau, Amy, The University of Arizona College of Medicine Tucson, Tucson, Arizona, United States
Introduction
BK virus nephropathy (BKVN) is an opportunistic infection that can lead to progressive kidney dysfunction. Classically described in the allograft of kidney transplant patients, it is increasingly recognized in native kidneys of other non-renal solid organ transplants (NRSOTs). Here we describe a patient with a history of lung transplant with native BKVN.
Case Description
Our 68-year-old woman with a history of bilateral lung transplant for idiopathic pulmonary fibrosis was referred thirteen months post-transplant for worsening renal function. Her creatinine slowly increased from a baseline of 0.6 mg/dL to 1.9 mg/dL. Work up revealed a serum BK virus PCR level of 28,381,300 copies/ml. Kidney biopsy revealed numerous tubular epithelial cells with enlarged nuclei and intranuclear inclusions (Figure A) which stained positive for SV 40 (Figure B). Her tacrolimus and sirolimus were already reduced by the lung transplant team. Mycophenolic acid was discontinued. She was already on monthly intravenous immunoglobulin, and so she was admitted for intravenous cidofovir. Her creatinine preceding cidofovir treatment was 2.2 mg/dL with a serum BK virus PCR of 59,225,688 copies/ml. Unfortunately, after a total of 2.5 mg/kg of intravenous cidofovir, her creatinine worsened to 4.68 mg/dL with no significant change in BK viremia. Cidofovir was discontinued.
Discussion
Native BKVN is more common than previously recognized in NRSOTs. There is unclear guidance if lung transplant patients should be screened for BK viremia routinely, and there is a lack of safe and efficacious treatment options. This case adds to the growing literature of lung transplant recipients who develop native BKVN and the challenges of BKVN treatment beyond reduction of immunosuppression.