Risk Factors for BK Virus Infection and BK Virus–Associated Nephropathy Under the Impact of Intensive Monitoring and Pre-emptive Immunosuppression Reduction

Evaluation of the predisposition and clinical impact of BK virus replication in kidney transplant patients

“…In some studies, the use of TAC associated with mycophenolate mofetil (MMF) was alleged to represent a high risk factor for BKV infection activation (Brennan et al 2005, Koukoulaki et al 2009). In another study, the incidence of BKVN was lower in subjects who received CsA and MMF than in those who did not receive this immunosuppression (Huang et al 2014). In the present study, a strong risk association was observed between MPS-based treatment and 682 ELVIANI B. MOURA et al…”

“…In a study by Huang et al (2014), the association with BKV replication was lower in patients who received their kidneys from a living donor than in those who received a deceased donor graft. This same study also noted that kidneys transplanted from deceased donors using TAC tended to have an increased risk of BKV infection development.…”

“…The risk factors for BKV reactivation are not completely understood but may include factors related to the donor, recipient, kidney graft and type of immunosuppression used (Medeiros et al 2008, Huang et al 2014. Among other variables, a weakened immune status, advanced age, male gender, Caucasian ethnicity and diabetes have been proposed as risk factors for BKV manifestation (Zalona et al 2013).…”

“…Uncertainty regarding the risk factors predisposing a patient to viral replication is an aggravating factor for the occurrence of BKVN (Huang et al 2014). Medeiros et al (2008) proposed cytomegalovirus (CMV) co-infection, the absence of the HLA-C7 allele and the donor being deceased as risk factors inherent to the donor.…”

Impact of low‐level BK polyomavirus viremia on intermediate‐term renal allograft function

“…Primary infection with BKPyV occurs mainly in the first decade of life as evidenced by BKPyV seroprevalence of up to 90% in adults . Immunosuppressive therapy based on tacrolimus‐mycophenolic acid and low or absent BKPyV‐specific T‐cell responses after kidney transplantation are important risk factors for BKPyV reactivation . As PyVAN is preceded by high levels of BKPyV viruria and viremia, it is highly recommended to implement regular follow‐up examinations with screening for BKPyV replication in serum after renal transplantation .…”