Supavit Chesdacha
1,2, Charat Thongprayoon
3, Jackrapong Bruminhent
2, Wisit Cheungpasitporn
4,5*1 Department of Medicine, University of Minnesota, Minnesota, USA
2 Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
3 Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
4 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
5 Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Mississippi, USA
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.
Implication for health policy/practice/research/medical education:
This review aims to present the evidence of benefit-risk assessment of cidofovir treatment for BK virus infection in kidney
transplant recipients. In this review, we discussed the efficacy and adverse side effects, which help physicians in the clinical
judgment for the use of cidofovir addition to a reduction of immunosuppressant. Moreover, this review also provides brief review
of current view in BK virus burden, clinical manifestation, diagnosis and other treatment methods which can be beneficial in
clinical practice and future research.
Please cite this paper as: Chesdachai S, Thongprayoon C, Bruminhent J, Cheungpasitporn W. Efficacy and adverse effects of
cidofovir for treatment of BK virus infection in kidney transplant recipients. J Nephropharmacol. 2018;7(1):10-17. DOI: 10.15171/
npj.2018.04.