P-164

BK nephropathy (BKVN) in simultaneous pancreas -kidney transplant (SPK): potentially preventable cause of renal allograft loss

P. Kandula, T. Taber, J. Fridell, M. Yaqub, D. Mishler, A. Sharfuddin, M. Mujtaba
Indiana University School of Medicine, Indianapolis, USA

Background: Immunosuppression (IS) reductionis the main stay of BKVN management; this approach can put SPK patients (pts) ata high risk of pancreatic allograft rejection. This fear of pancreaticrejection leads to inadequate BKVN management in SPK pts. More than 50% of SPK ptsafflicted with BKVN lose their kidneys.

Methods: Single center, retrospective case study reviewed the dataof 138 SPK patients from 1/06 to 6/10. BKVN definition was qPCR > 10000copies/ml of serum and > 30% rise inseurm creatinine from baseline. Induction was with r- ATG and maintenancesteroid free IS with Tacrolimus ± Sirolimus or Mycophenolate. Quarterly urinescreening for BK virus was done for first two years and once a year thereafter.

Results: 6 patients were diagnosed with BKVN.Mean time to diagnosis was 13 months. Median serum creatinine was 2.1 mg/dl atdiagnosis. The geometric mean BK serum viral load was 1,758,000 DNA copies/ml.Patients were managed with IS reduction alone with biweekly monitoring of BK viralloads and blood chemistries. Median time to BKVN clearance was 5.6 months. Norenal allograft was lost to BKVN. From BKVN diagnosis to clearance there was a96% reduction of Mycophenolate Mofetil dose. 100% reduction in Sirolimus and40% reduction in 12hr Tacrolimus trough level. At a Median 19 month pt follow up postBK clearance, pts had excellent renal function without evidence of pancreaticallograft loss.

Conclusion: Early detection and interventionin BKVN by Immunosuppression reduction alone with close monitoring of renal andpancreatic allograft function can potentially prevent renal allograft loss inSKPT without compromising pancreatic allograft

P-164

BK nephropathy (BKVN) in simultaneous pancreas -kidney transplant (SPK): potentially preventable cause of renal allograft loss

P. Kandula, T. Taber, J. Fridell, M. Yaqub, D. Mishler, A. Sharfuddin, M. Mujtaba
Indiana University School of Medicine, Indianapolis, USA

Background: Immunosuppression (IS) reductionis the main stay of BKVN management; this approach can put SPK patients (pts) ata high risk of pancreatic allograft rejection. This fear of pancreaticrejection leads to inadequate BKVN management in SPK pts. More than 50% of SPK ptsafflicted with BKVN lose their kidneys.

Methods: Single center, retrospective case study reviewed the dataof 138 SPK patients from 1/06 to 6/10. BKVN definition was qPCR > 10000copies/ml of serum and > 30% rise inseurm creatinine from baseline. Induction was with r- ATG and maintenancesteroid free IS with Tacrolimus ± Sirolimus or Mycophenolate. Quarterly urinescreening for BK virus was done for first two years and once a year thereafter.

Results: 6 patients were diagnosed with BKVN.Mean time to diagnosis was 13 months. Median serum creatinine was 2.1 mg/dl atdiagnosis. The geometric mean BK serum viral load was 1,758,000 DNA copies/ml.Patients were managed with IS reduction alone with biweekly monitoring of BK viralloads and blood chemistries. Median time to BKVN clearance was 5.6 months. Norenal allograft was lost to BKVN. From BKVN diagnosis to clearance there was a96% reduction of Mycophenolate Mofetil dose. 100% reduction in Sirolimus and40% reduction in 12hr Tacrolimus trough level. At a Median 19 month pt follow up postBK clearance, pts had excellent renal function without evidence of pancreaticallograft loss.

Conclusion: Early detection and interventionin BKVN by Immunosuppression reduction alone with close monitoring of renal andpancreatic allograft function can potentially prevent renal allograft loss inSKPT without compromising pancreatic allograft