BK virus as a mediator of graft dysfunction following kidney transplantation

Yi, Stephanie G.; Knight, Richard J.; Lunsford, Keri E.

doi:10.1097/mot.0000000000000429

Cited by 20 publications

(22 citation statements)

References 66 publications

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“…In particular, long-term modified immunosuppression in the treatment of BKVN may be associated with a higher incidence of chronic rejection and the rise of de novo DSA formation in a recipient with persistent BKV viraemia 74,79 . Bioptically verified acute cellular or humoral rejection represents, according to one of the studies, a higher risk of graft loss than it was observed in BKVN alone 41 .…”

Section: Bkvn Screening and Prophylaxismentioning

confidence: 94%

“…The prevalence of BKVN in kidney transplants indicates an important role of primary damage to the renal graft, which facilitates the subsequent development of BKVN and contrasts with the relatively rare occurrence of BKVN in non-renal solid organ transplants. However, even in these patients, it is currently advisable to perform BKV screening in the first year after transplantation in the case of deterioration of native kidney function 41 . Similar recommendations for early screening of BKV viraemia also apply to paediatric heart recipients 38 .…”

Section: Other Factors Contributing To Bkvn Developmentmentioning

confidence: 99%

“…More than 10 7 copies/mL of viral DNA in urine or urinary VP-1 mRNA with an amount greater than 6.5 x 10 5 copies/ng of total RNA are considered significant viral DNA secretion in urine analysis and more than 10 4 copies/mL if plasma DNA testing is used. However, some authors consider plasma BKV viraemia higher than 500 copies/mL significant and recommend such patients for biopsy 41 . If full blood is used in PCR screening, consideration should also be given to the possible institutional variability in the sensitivity and specificity of PCR methods 52 .…”

Section: Bkvn Screening and Prophylaxismentioning

confidence: 99%

“…If performed routinely, it will help detect BKV replication even before graft damage. If pathological changes associated with BKVN develop, the management of renal damage is more difficult 41,80 . The effect of the measures is monitored by plasma PCR-BKV until its negativity.…”

Section: Bkvn Screening and Prophylaxismentioning

confidence: 99%

“…The specific viral epitopes optimal for targeted T cell expansion are currently the subject of research 93 . Genetic modifications to the responder T cells can allow them to survive longer, and they can subsequently also act as a prevention of the disease 41 . The obtained data suggest that adoptive transfer of BKV-reactive T lymphocytes has the potential to improve BKV-associated disability and may provide a significant therapeutic benefit for patients with BKVN or haemorrhagic cystitis.…”

Section: Possibilities Of Bkvn Immunotherapymentioning

confidence: 99%

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BK virus-induced renal allograft nephropathy

Krejčí¹,

Tichý²,

Bednaříková³

et al. 2018

BIOMED PAP

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BK virus nephropathy (BKVN) is a serious opportunistic infection threatening renal function especially during the first year after transplantation. Its incidence is now on the rise and is closely related to the level of the recipient's immune system inhibition. This is more intensive with current trends in transplantation medicine, where more potent immunosuppressive protocols are used and more aggressive antirejection therapy is applied. In the absence of BK virus (BKV) specific therapy and limited treatment options for advanced BKVN, active screening of BKV replication and subsequent preemptive adjustment of immunosuppression are essential measures to prevent BKVN. However, it remains unclear how to modify immunosuppressive protocols as well as how to address initial stages of BKV replication. This comprehensive review summarizes the currently applied and not completely uniform procedures for the detection, prophylaxis and therapy of BKV replication and BKVN. The pitfalls brought by reduced immunosuppression, as a typical response to a significant viral replication or a developed BKVN, are also mentioned, particularly in the form of graft rejection. The paper also outlines the authors' experiences, and lists currently ongoing studies on the subject. The perspectives of new, especially immune-based, procedures in the treatment of complications associated with BKV infections are highlighted. Different views on the management of patients indicated for kidney re-transplantation whose previous graft failed because of BKVN are also discussed.

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Section: Bkvn Screening and Prophylaxismentioning

confidence: 94%

Section: Other Factors Contributing To Bkvn Developmentmentioning

confidence: 99%

Section: Bkvn Screening and Prophylaxismentioning

confidence: 99%

Section: Bkvn Screening and Prophylaxismentioning

confidence: 99%

Section: Possibilities Of Bkvn Immunotherapymentioning

confidence: 99%

See 3 more Smart Citations

BK virus-induced renal allograft nephropathy

Krejčí¹,

Tichý²,

Bednaříková³

et al. 2018

BIOMED PAP

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Nephrotoxicity of calcineurin inhibitors as a risk factor for BK polyomavirus replication after kidney transplantation

Krejčí

Tichý

Bednaříková

et al. 2020

Journal of Medical Virology

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BK polyomavirus‐associated nephropathy (PyVAN) is responsible for a significant percentage of transplanted kidneys prematurely terminating their function. Its occurrence is closely related to the intensity of immunosuppressive therapy. In a group of 161 newly transplanted patients, we prospectively evaluated 457 protocol renal biopsies performed within the first year after transplantation. Using the calcineurin inhibitors (CI) nephrotoxicity score, the incidence of nephrotoxicity was monitored as a manifestation of excessive immunosuppression. Findings were correlated with clinical evidence of active BK polyomavirus (BKPyV) replication and PyVAN. Compared to the normal histology, nephrotoxicity was associated with more frequent BKPyV viremia and viruria (p = .01 and p < .01, respectively) and more common occurrence of PyVAN. The persistence of toxicity in the subsequent biopsy proved to be a negative risk factor of viremia and viruria (p = .03 and p < .01, respectively), independently of the initial BKPyV status. Toxicity could also be used as a predictor of viremia and viruria (p = .04 and p < .01, respectively) even in the absence of viral replication at the time of initial biopsy. The early histological manifestation of CI nephrotoxicity was associated with significant BKPyV reactivation in the risky first posttransplant year.

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Kidney transplantation: the recipient

2024

Living Donor Organ Transplantation

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BK virus as a mediator of graft dysfunction following kidney transplantation

Abstract: Early screening for BK combined with reduction of immunosuppression remains the mainstay of treatment for BK viraemia. New therapeutic advances demonstrate promise in vitro; however, the in-vivo efficacy will be demonstrated by future studies.

Cited by 20 publications

References 66 publications

BK virus-induced renal allograft nephropathy

BK virus-induced renal allograft nephropathy

Nephrotoxicity of calcineurin inhibitors as a risk factor for BK polyomavirus replication after kidney transplantation

Kidney transplantation: the recipient

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