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JAC Advance Access published online on July 25, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn305
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading article

Antiviral therapy for polyomavirus-associated nephropathy after renal transplantation

Rachel Hilton1 and C. Y. William Tong2,3,*

1 Renal, Transplant and Urology Services, Guy's and St Thomas' NHS Foundation Trust, London, UK 2 Infection and Immunology Services, Guy's and St Thomas' NHS Foundation Trust, London, UK 3 Department of Infectious Diseases, King's College London School of Medicine, London, UK

* Correspondence address. Infection and Immunology, 5th Floor North Wing, St Thomas' Hospital, London SE1 7EH, UK. Tel: +44-20-71883147; Fax: +44-20-71883146; E-mail: william.tong{at}gstt.nhs.uk

Polyomavirus-associated nephropathy (PVAN) has recently emerged as an important cause of allograft failure following renal transplantation. The BK virus is the most important polyomavirus associated with this condition. The mainstay of therapy for PVAN is a prompt immunosuppressive dose reduction in conjunction with careful monitoring for BK viraemia. A number of antiviral agents have been tried to help to reduce BK viral replication. So far, there has been only a single randomized controlled study on the use of one of these agents. Pooled data from various small case series did not show significant differences in outcome. Prospective randomized studies with a standardized protocol are urgently required.

Key Words: BK virus , renal transplantation , cidofovir , leflunomide , fluoroquinolones , intravenous immunoglobulin


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