Polyomavirus Nephropathy: Ten-Year Experience

Costa, Joana; Ferreira, E.; Leal, Rita; N, Bota; Romãozinho, Catarina; Sousa, Vítor; Marinho, Carol; Santos, Lídia; Macário, Fernando; Alves, Rui; Pratas, Jorge; Campos, Mário; Figueiredo, Arnaldo

doi:10.1016/j.transproceed.2017.01.072

Cited by 9 publications

(2 citation statements)

References 6 publications

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“…Early diagnosis of BKVN usually results in better allograft survival than the advanced disease [43,46]. Due to limited treatment options, screening for BKPyV replication is recommended to avoid further kidney histologic involvement.…”

Section: Screening and Diagnosismentioning

confidence: 99%

BK Polyomavirus Nephropathy in Kidney Transplantation: Balancing Rejection and Infection

Shen

Lien

et al. 2021

Viruses

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BK polyomavirus nephropathy (BKVN) and allograft rejection are two closely-associated diseases on opposite ends of the immune scale in kidney transplant recipients. The principle of balancing the immune system remains the mainstay of therapeutic strategy. While patient outcomes can be improved through screening, risk factors identification, and rapid reduction of immunosuppressants, a lack of standard curative therapy is the primary concern during clinical practice. Additionally, difficulty in pathological differential diagnosis and clinicopathology’s dissociation pose problems for a definite diagnosis. This article discusses the delicate evaluation needed to optimize immunosuppression and reviews recent advances in molecular diagnosis and immunological therapy for BKVN patients. New biomarkers for BKVN diagnosis are under development. For example, measurement of virus-specific T cell level may play a role in steering immunosuppressants. The development of cellular therapy may provide prevention, even a cure, for BKVN, a complex post-transplant complication.

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Section: Screening and Diagnosismentioning

confidence: 99%

BK Polyomavirus Nephropathy in Kidney Transplantation: Balancing Rejection and Infection

Shen

Lien

et al. 2021

Viruses

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“…Other identified risk factors that have been proposed include male sex, age of both donor and recipient [ 16 ], obesity [ 15 ], and donors and recipients serostatus of both BKV and Cytomegalovirus (CMV) [ 15 ]. Also, factors such as long cold ischemia time [ 15 ] and delayed graft function [ 15 , 17 ] have been suggested to be of interest. There are only a few prospective studies with multivariable analyses of risk factors and most included less than 500 patients [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Developing BK Virus-Associated Nephropathy: A Single-Center Retrospective Cohort Study of Kidney Transplant Recipients

et al. 2021

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Background BK virus (BKV) infection after kidney transplantation leads to BKV-associated nephropathy (BKVAN) in up to 10% of recipients, and is associated with an increased risk of allograft dysfunction or loss. The objective of this study was to estimate the incidence of BKVAN and to analyze whether enhanced induction is associated with an increased risk of BKVAN, possibly justifying more intensive surveillance. Material/Methods This was a single-center retrospective cohort study. All patients who underwent kidney transplantation or simultaneous pancreas and kidney transplantation at the Uppsala University Hospital in Sweden between 2005 and 2014 were included, a period when BKV screening was not yet implemented. The effect of enhanced induction, defined as treatment with thymoglobulin, rituximab, and/or eculizumab, often in combination with IVIg and glycosorb, immunoadsorption and/or plasmapheresis/apheresis, was analyzed in a multivariable Cox proportional hazards model together with sex, age, cytomegalovirus mismatch (donor+/recipient−) and rejection treatment as co-predictors. Further, the effects of BKVAN on graft survival was analyzed in a univariable Cox proportional hazards model. Results In total 44 of 928 (4.7%) patients developed a biopsy-verified BKVAN 4.8 (1.5–34.2) months after transplantation. Male sex was identified as a risk factor (HR 2.02, P =0.04) but not enhanced induction. Patients with BKVAN experienced a significantly higher risk of graft loss (HR 4.37, P <0.001). Conclusions Male sex, but not enhanced induction, was found to be a risk factor for BKVAN development after kidney transplantation. BKVAN is associated with an increased risk of graft loss.

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Polyomavirus Nephropathy: Ten-Year Experience

Abstract: GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL.

Cited by 9 publications

References 6 publications

BK Polyomavirus Nephropathy in Kidney Transplantation: Balancing Rejection and Infection

BK Polyomavirus Nephropathy in Kidney Transplantation: Balancing Rejection and Infection

Risk Factors for Developing BK Virus-Associated Nephropathy: A Single-Center Retrospective Cohort Study of Kidney Transplant Recipients

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