Fluoroquinolones for BK viral complication after transplantation: Meta‐analysis

Objectives BK polyomavirus (BKV) causes two distinct complications after transplantation, hemorrhagic cystitis (BKV‐HC) after hematopoietic stem cell transplantation (HSCT), and BKV‐associated nephropathy (BKVAN) after kidney transplantation (KT). Although fluoroquinolones show efficacy against BKV proliferation in vitro, the clinical effect remains uncertain; thus, we performed meta‐analysis to assess its efficacy in the prophylaxis. Methods Articles published before March 2020 were searched from PubMed, the Cochrane Library, ISRCTN registry, and ClinicalTrials.gov. Primary outcomes were BKV‐HC after HSCT and BKVAN after KT. Secondary outcomes were BK viremia, viruria after KT, and fluoroquinolone‐related adverse events. Results Three trials with 281 patients post‐HSCT and 11 trials with 1882 patients post KT were included as for prophylaxis. Fluoroquinolone prophylaxis did not show effects on BKV‐HC (OR 0.54, 95% CI 0.13‐2.25), BKVAN (OR 0.74, 95% CI 0.35‐1.55), and BK viremia (OR 0.79, 95% CI 0.49‐1.28), but significantly decreased BK viruria (OR 0.64, 95% CI 0.45‐0.91). Fluoroquinolone prophylaxis was associated with the higher percentage of fluoroquinolone‐resistant infection among identified bacteria (OR 2.38, 95% CI 1.16‐4.88), but the incidence of fluoroquinolone‐resistant infection was similar (OR 1.15, 95% CI 0.71‐1.86), due to the decrease of infection itself (OR 0.52, 95% CI 0.34‐0.81). Conclusions This meta‐analysis showed that fluoroquinolones did not prevent BKV‐HC after HSCT or BKVAN after KT, although the effect against BKV‐HC should be further investigated by randomized controlled trials. Fluoroquinolones could reduce the rate of BK viruria to some extent but may not have clinically sufficient effects.