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Abstract: SA-PO870

BK Nephropathy in Hematopoietic Stem Cell Transplant Patients: An Upcoming Challenge

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Fareedy, Shoaib Bilal, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Khan, Rana Raheel Hafeez, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Tchakarov, Amanda, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States
  • Mamlouk, Omar, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Introduction

Nephropathy from BK virus (BKV) infection is a known challenge in the context of kidney transplant patients. Usually, a consequence of potent IS aimed at reducing acute rejection and improving allograft survival. Moreover, it can also be encountered in recipients of HSCT on IS to prevent or treat GVHD and can lead to progressive CKD and poor overall survival. As the number of HSCT patients is increasing worldwide, evidence-based guidelines are required, to combat potential loss of kidney function in these patients. Decreasing IS remains the principal treatment of BKV nephropathy in kidney transplant patients but predisposes to allograft rejection. Antiviral medications including leflunomide, cidofovir, quinolones, and intravenous Ig have been used with variable outcome and with risk for nephrotoxicity. In recipients of SCT there are no established guidelines to help with the diagnosis and treatment of BK nephropathy

Case Description

We present a case of a 39-year-old male with a history of AML who underwent cord blood allogenic stem cell transplant in March 2021. He developed gastrointestinal GVHD and was treated for fungal pneumonia. 8 weeks post-transplant he started to have gradual decline in kidney function with rise in serum creatinine from 3.38 mg/dl to 5.65 mg/dl over 12 weeks. Urine was bland with no microscopic hematuria, pyuria, or proteinuria. US guided biopsy revealed tubulointerstitial injury attributed to BK tubulopathy. BK level in the blood was of 184,000 copies/ml and in the urine of 4.70E+ 09 copies/ml. Tacrolimus was tapered down and switched to sirolimus. Unfortunately, patient continued to have a steady decline in renal function and is now being prepared to initiate RRT.

Discussion

BK virus in HSCT recipient is usually asymptomatic infection, when it manifests clinically, the most common presentation is dysuria and hematuria (hemorrhagic cystitis). BK related nephropathy is a rare complication. Treatment of BK nephropathy in HSCT recipients is challenging and beside decreasing IS, there is still no consensus about effective therapy, and this can lead to progressive CKD. BKV-specific Cytotoxic T cell infusion is currently under investigation for treatment of BK related cystitis. Future studies are needed to evaluate its efficacy and other potential targeted therapies in treating BK nephropathy.