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. 2021 Oct 2;22(1):328.
doi: 10.1186/s12882-021-02527-3.

Conversion from mycophenolate mofetil to mizoribine in the early stages of BK polyomavirus infection could improve kidney allograft prognosis: a single-center study from China

Ping Li  1 , Dongrui Cheng  1 , Jiqiu Wen  1 , Xuefeng Ni  1 , Kenan Xie  1 , Xue Li  1 , Jinsong Chen  2
Affiliations

Conversion from mycophenolate mofetil to mizoribine in the early stages of BK polyomavirus infection could improve kidney allograft prognosis: a single-center study from China

Ping Li et al. BMC Nephrol. .

Abstract

Background: Some studies have suggested mizoribine (MZR) could inhibit the replication of BK polyomavirus (BKPyV). The purpose of this study was to explore whether conversion from mycophenolate mofetil (MMF) to MZR in the early stages of BKPyV infection can improve kidney allograft prognosis.

Methods: Twenty-one kidney transplant recipients with BKPyV viruria/viremia and ten with BK polyomavirus-associated allograft nephropathy (BKPyVAN) received MZR conversion therapy were retrospectively identified. The clearance rate of urine and blood BKPyV DNA, change of serum creatinine (SCr), uric acid (UA), hemoglobin (HB), white blood cell (WBC), lymphocyte ratio, platelet (PLT), routine urinalysis, panel reactive antibody (PRA), and gastrointestinal disorders during follow-up of the 2 groups were evaluated and compared.

Results: After MZR conversion therapy, the clearance rate of urine and blood viral load in BKPyV viruria/viremia group were 85.7 and 100 %, while that in BKPyVAN were 40 and 87.5 %, respectively. Stable SCr were observed in all cases of BKPyV viruria/viremia group, while that of BKPyVAN was only 40 % (P < 0.001) and one even progressed to end-stage renal disease. The results of routine urinalysis in the two groups showed no significant changes before and after MZR conversion therapy. However, in BKPyV viruria/viremia group, four cases developed acute rejection and one had positive PRA-II but no donor specific antibody, requiring conversion back to MMF. Hyperuricemia was the common adverse effect of MZR.

Conclusions: Conversion from MMF to MZR could help clear BKPyV infection. As compared to BKPyVAN, patients who underwent initiation of MZR conversion therapy in the early stages of BKPyV infection maintained stable allograft function. Prospective studies with larger sample size are needed to ascertain this preliminary finding.

Keywords: BK polyomavirus; BK polyomavirus-associated allograft nephropathy; Mizoribine; renal transplantation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Histopathological features of BK polyomavirus-associated allograft nephropathy (BKPyVAN). (A) Light microscope image of BKPyVAN. The histological manifestations are characterized by nuclear inclusion bodies in tubular epithelial cells (arrow, Hematoxylin-Eosinstained paraffin section, ×400). (B) Immunostaining of BK polyomavirus-infected cells with anti-SV40 large T antigen antibodies showing the nuclei of renal tubular epithelial cells have a transparent center and thorn-shaped periphery (arrow indicates the immunohistochemical staining, ×400)
Fig. 2
Fig. 2
Changes of the urine and blood BK polyomavirus (BKPyV) DNA positive rate after mizoribine conversion therapy. (A) Changes of the urine BKPyV DNA positive rate. The urine BKPyV DNA positive rate were decreased in 2 groups, especially the BKPyV viruria/viremia group. The negative conversion rate of urine viral load in BKPyV viruria/viremia group and BK polyomavirus-associated allograft nephropathy (BKPyVAN) group were 85.7 and 40 %, respectively. (B) Changes of the blood BKPyV DNA positive rate. The blood BKPyV DNA, DNA positive rate was significantly decreased in the 2 groups and the negative conversion rate of blood viral load in BKPyV viruria/viremia group and BKPyVAN group were 100 and 87.5 %, respectively
Fig. 3
Fig. 3
Changes of the serum creatinine (SCr) after mizoribine conversion therapy. (A) a stable SCr was observed in BK polyomavirus (BKPyV) viruria/viremia group, while that of BK polyomavirus-associated allograft nephropathy (BKPyVAN) group was increased progressively. (B) There were only 4/10(40 %) patients (case2, 5, 7, 9) in BKPyVAN group had a stable SCr, while the rest of the patients had a progressive increase SCr and one (case 3) even progressed to end-stage renal disease
Fig. 4
Fig. 4
Changes of the blood uric acid (UA) after mizoribine (MZR) conversion therapy. The UA of the BK polyomavirus (BKPyV) viruria/viremia group and BK polyomavirus-associated allograft nephropathy (BKPyVAN) group were increased after MZR treatment and was easily controlled by uric-acid-lowering drugs such as benzbromarone, or febuxostat
Fig. 5
Fig. 5
Changes of the hematologic parameters after mizoribine (MZR) conversion therapy. The white blood cell (WBC) count (A), lymphocyte ratio (B), hemoglobin (HB) (C) and blood platelet (PLT) (D) of the BK polyomavirus (BKPyV) viruria/viremia group and BK polyomavirus-associated allograft nephropathy (BKPyVAN) group were stable after MZR treatment
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References

    1. Hirsch HH, Randhawa PS, AST Infectious Diseases Community of Practice BK polyomavirus in solid organ transplantation-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13528. doi: 10.1111/ctr.13528. - DOI - PubMed
    1. Hirsch HH, Randhawa P, AST Infectious Diseases Community of Practice BK polyomavirus in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):179–88. doi: 10.1111/ajt.12110. - DOI - PubMed
    1. Vigil D, Konstantinov NK, Barry M, et al. BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection. World J Transplant. 2016;6(3):472–504. doi: 10.5500/wjt.v6.i3.472. - DOI - PMC - PubMed
    1. Ramos E, Drachenberg CB, Wali R, Hirsch HH. The decade of polyomavirus BK-associated nephropathy: state of affairs. Transplantation. 2009;87(5):621–30. doi: 10.1097/TP.0b013e318197c17d. - DOI - PubMed
    1. Oshiro Y, Nakagawa K, Hoshinaga K, et al. A Japanese multicenter study of high-dose mizoribine combined with cyclosporine, basiliximab, and corticosteroid in renal transplantation (the fourth report). Transplant Proc. 2013; 45(4): 1476-80. - PubMed