BK Virus Infection and Its Management in Renal Transplantation: An Update

Abstract

BK virus (BKV) is a common opportunistic pathogen in kidney transplant recipients and one of the most challenging causes of allograft dysfunction and loss. Although over-immunosuppression remains the primary risk factor for BKV infection after transplantation, male gender, older recipient age, prior rejection episodes, degree of human leukocyte antigen mismatching, prolonged cold ischemia time, BK virus serostatus and ureteral stent placement have all been implicated as risk factors. Routine screening post-renal transplant is important to prevent allograft loss in patients with BK viruria or viremia. Reduction of immunosuppression remains the mainstay of BKV nephropathy treatment and is the most studied intervention. In this review, we are going to discuss the epidemiology of BK virus infection, screening strategies, treatment options and new studies or evidence in the future.

A quick algorithmic review on management of viral infectious diseases in pediatric solid organ transplant recipients

“…If a positive result is obtained from the urine test, confirmation with plasma PCR is necessary ( 102 ). Furthermore, monitoring the response to therapy through urine BKPyV PCR is less effective compared to plasma because the decrease in immunosuppression shows a delay in changes in urine viral load compared to plasma viral load ( 103 ). AST guideline recommended to screen on a monthly basis for the first 9 months, and then every 3 months for the following 2 years ( Figure 11 ) ( 98 ).…”

BK polyomavirus infection: more than 50 years and still a threat to kidney transplant recipients

“…In one study, 78% of infected patients were still viremic 4 weeks after diagnosis and the initiation of immunosuppression reduction, and 61.5% of viremic at 3 months ( 52 ). For most individuals, persistent infections at low levels are clinically silent and not associated with adverse outcomes ( 66 , 72 ). However, persistent high BKPyV viremia was associated with BKPyVAN and graft dysfunction ( 66 ).…”