Efficacy and adverse effects of cidofovir for treatment of BK virus infection in kidney transplant recipients

Abstract

Kidney transplant provides patients with end-stage kidney disease a clear survival benefit compared to patients who remain on dialysis. Immunosuppressive therapy is crucial for maintaining graft survival. However, high level of suppression can increase the susceptibility for BK virus reactivation following transplantation, leading to BK virus-associated nephropathy (BK-VAN) and allograft loss. Its clinical presentations are often asymptomatic or solely rising of serum creatinine. While reduction of immunosuppression remains the mainstay treatment of BK viremia/nephropathy, there have been many proposed adjuvant therapy such as antiviral agents, fluoroquinolone, immunoglobulin, and immunotherapy. Cidofovir is one of the adjuvant therapies that have been studied in many case series and cohort studies with unclear data on benefit-risk assessment. This review aims to present the current literature on the efficacy, potential adverse effects and cost-effectiveness of cidofovir treatment for BK viremia/nephropathy.

Keywords

• BK virus
• Cidofovir
• Kidney transplantation
• Polyoma virus
• Transplantation