Advances in BK Virus Complications in Organ Transplantation and Beyond

Cohen‐Bucay, Abraham; Ramirez-Andrade, Silvia E.; Gordon, Craig E.; Francis, Jean; Chitalia, Vipul C.

doi:10.1016/j.xkme.2020.06.015

Cited by 29 publications

(37 citation statements)

References 140 publications

(377 reference statements)

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“…However, there are wide variations in the strategy to adjust immunosuppression among different transplant centres 67,68 . Current data supporting mTOR inhibitor‐based immunosuppression as treatment for BKV infection are limited and further randomized studies are required on this aspect 69 . Since BKV nephropathy has been associated with the development of class II de‐novo DSAs, 70 the immunological risk of the patient has to be considered and a personalized approach to immunosuppression adjustment is needed.…”

Section: Bk Polyomavirus‐associated Nephropathymentioning

confidence: 99%

Personalized immunosuppression after kidney transplantation

Cheung

Tang

2022

Nephrology

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With advances in immunosuppressive therapy, there have been significant improvements in acute rejection rates and short-term allograft survival in kidney transplant recipients.However, this success has not been translated into long-term benefits by the same magnitude. Optimization of immunosuppression is important to improve the clinical outcome of transplant recipients. It is important to note that each patient has unique attributes and immunosuppression management should not be a one-size-fits-all approach. Elderly transplant patients are less likely to develop acute rejection but more likely to die from infectious and cardiovascular causes than younger patients. For those with posttransplant cancers and BK polyomavirus-associated nephropathy, reduction of immunosuppression can increase the risk of rejection. Therapeutic drug monitoring (TDM) is routinely used for dosage adjustment of several immunosuppressive drugs. It has been hoped that pharmacogenetics can be used to complement TDM in optimizing drug exposure. Among the various drug-genotype pairs being investigated, tacrolimus and CYP3A5 gives the most promising results. Different studies have consistently shown that CYP3A5 expressers require a higher tacrolimus dose and take longer time to achieve target blood tacrolimus levels than nonexpressers. However, for pharmacogenetics to be widely used clinically, further trials are necessary to demonstrate the clinical benefits of genotypeguided dosing such as reduction of rejection and drug-related toxicities. The development of different biomarkers in recent years may help to achieve true personalized therapy in transplant patients.

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Section: Bk Polyomavirus‐associated Nephropathymentioning

confidence: 99%

Personalized immunosuppression after kidney transplantation

Cheung

Tang

2022

Nephrology

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“…BKV reactivation can manifest as viruria in 30% to 40% of kidney transplant recipients (KTR), viremia in 10% to 20% or BKV-associated nephropathy in 1% to 10% of patients according to published series [3,4]. Importantly, it is estimated that BKV-associated nephropathy (BKVAN) is associated with a 50% increased risk of graft loss [5].…”

Section: Introductionmentioning

confidence: 99%

BK Virus and Cytomegalovirus Coinfections in Kidney Transplantation and Their Impact on Allograft Loss

Herrera

Bernal-Maurandi

Cofan

et al. 2021

JCM

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We aimed to ascertain the interaction and effects of combined reactivations of BK virus and cytomegalovirus on kidney graft function. All consecutive kidney transplant recipients (KTR) between 2003 and 2016 were included. Of 1976 patients who received a kidney transplant, 23 (1.2%) presented BKV-associated nephropathy (BKVAN). Factors independently associated with BKVAN were diabetes mellitus (odds ratios (OR) 3.895%, confidence intervals (CI) (1.4–10.5)), acute allograft rejection (OR 2.8 95%, CI (1.1–7.6)) and nephrostomy requirement (OR 4.195%, CI (1.3–13)). Cytomegalovirus infection was diagnosed in 19% of KTR patients. Recipients with BKVAN presented more frequently with cytomegalovirus (CMV) infection compared to patients without BKVAN (39% vs. 19%, p = 0.02). Acute allograft rejection (OR 2.95%, CI (1.4–2.4)) and nephrostomy requirement (OR 2.95%, CI (1.2–3)) were independently associated with CMV infection. Sixteen patients (69%) with BKVAN had graft dysfunction at one-year post-transplant and eight of them (35%) lost their graft. Patients presenting with BKVAN and graft loss presented more frequently a cytomegalovirus infection (OR 2.295%, CI (1.3–4.3)). In conclusion, we found a relation between CMV infection and graft loss in patients presenting BKVAN, suggesting that patients with CMV reactivation should be actively screened for BKV.

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“…The heterogeneity of BKN means that molecular classifiers for BKN will never be highly successful-BKN is not a class but a set of different classes. 12 The BKN classifier had a higher AUC than previous efforts at classifier development using the NanoString panel and FFPE samples, 22 presumably because we used intact RNA and genomewide measurements. Our study had the advantages of a large number of cases collected in a prospective study, high-quality RNA collected in RNALater rather than in FFPE, and a genome-wide microarray platform to discover gene associations rather than the limited number of probes on NanoString.…”

Section: Discussionmentioning

confidence: 92%