{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T14:01:20Z","timestamp":1790517680425,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,4,3]],"date-time":"2013-04-03T00:00:00Z","timestamp":1364947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Reduction in immunosuppression is considered the therapy of proven benefit for <jats:styled-content style=\"fixed-case\">BKV<\/jats:styled-content> infection in renal transplantation, but the use of leflunomide has also been reported. It was observed at this center that the patterns of viral load response while on leflunomide appear to fall into two distinct types.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Medical records of 22 kidney and kidney\u2010pancreas recipients at a single center who received leflunomide therapy for <jats:styled-content style=\"fixed-case\">BKV DNA<\/jats:styled-content>emia were reviewed. Information was collected on demographics, <jats:styled-content style=\"fixed-case\">BKV<\/jats:styled-content> viral loads, other antiviral therapy, immunosuppressive drug levels and doses, adverse effects, and graft and patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighteen of 22 cleared <jats:styled-content style=\"fixed-case\">BKV<\/jats:styled-content> viremia, and 12 of 22 had preserved allograft function; only two graft losses occurred in the screening era among leflunomide\u2010treated patients. Two patterns of viral load reduction were observed, termed the \u201csmooth\u201d and the \u201czigzag\u201d pattern, which differed in mean time to clear of <jats:styled-content style=\"fixed-case\">BKV DNA<\/jats:styled-content> (2.9 vs. 19.5\u00a0months, p\u00a0=\u00a00.0073). Graft preservation was correlated with lower serum creatinine (SCr) at the start of leflunomide therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Long courses and \u201czigzag\u201d fluctuations in viral load can occur in patients who eventually clear <jats:styled-content style=\"fixed-case\">BKV<\/jats:styled-content> on leflunomide with preserved allograft function. Intermittent increases in viral load do not necessarily portend therapeutic failure. Although the utility of leflunomide is still debated in the transplant community, this information may be useful to clinicians who choose to use it in selected patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.12110","type":"journal-article","created":{"date-parts":[[2013,4,3]],"date-time":"2013-04-03T06:57:42Z","timestamp":1364972262000},"source":"Crossref","is-referenced-by-count":12,"title":["Contrasting patterns of viral load response in transplant recipients with <scp>BK<\/scp> polyomavirus <scp>DNA<\/scp>emia on leflunomide therapy"],"prefix":"10.1111","volume":"27","author":[{"given":"Jennifer","family":"Cuellar\u2010Rodriguez","sequence":"first","affiliation":[{"name":"Department of Infectious Disease Medicine Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Stephany","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Glickman Urologic and Kidney Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Poggio","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Glickman Urologic and Kidney Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherif B.","family":"Mossad","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Medicine Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Goldfarb","sequence":"additional","affiliation":[{"name":"Department of Urology Glickman Urologic and Kidney Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Lard","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Glickman Urologic and Kidney Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Medhat","family":"Askar","sequence":"additional","affiliation":[{"name":"Allogen Laboratories, Surgery Institute, The Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Fatica","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Glickman Urologic and Kidney Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titte","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Glickman Urologic and Kidney Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Braun","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension Glickman Urologic and Kidney Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Shoskes","sequence":"additional","affiliation":[{"name":"Department of Urology Glickman Urologic and Kidney Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Flechner","sequence":"additional","affiliation":[{"name":"Department of Urology Glickman Urologic and Kidney Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven K.","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Medicine Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabin","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Medicine Institute Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin K.","family":"Avery","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Medicine Institute Cleveland OH 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