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Published on: July 13, 2019
BK virus nephropathy and kidney transplantation
Daniel L Bohl1, Daniel C Brennan
1Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Clinical Journal of the American Society of Nephrology : CJASN
|September 19, 2007
Summary
BK virus (BKV) nephropathy is a significant risk for kidney transplant patients due to immunosuppression. Early detection and management strategies, including reduced immunosuppression and supportive therapies, improve outcomes and allograft survival.
Area of Science:
- Nephrology
- Transplantation Immunology
- Virology
Background:
- Kidney transplant recipients face BK virus (BKV) nephropathy, a complication of potent immunosuppressive therapies used to prevent rejection and enhance graft survival.
- BKV infection can lead to kidney allograft dysfunction or loss if left untreated.
- Current primary treatment involves reducing immunosuppression, which paradoxically increases the risk of acute and chronic rejection.
Purpose of the Study:
- To review the challenges and evolving strategies in managing BK virus (BKV) nephropathy in kidney transplant recipients.
- To highlight the impact of immunosuppression on BKV infection and subsequent allograft outcomes.
- To discuss current and potential therapeutic approaches and the success of retransplantation.
Main Methods:
- Review of current literature on BKV nephropathy in kidney transplantation.
- Analysis of the role of immunosuppression in BKV pathogenesis and allograft outcomes.
- Evaluation of screening protocols, treatment options, and retransplantation success rates.
Main Results:
- Screening protocols have improved early detection and prevention of symptomatic BKV nephropathy, leading to better outcomes.
- While no specific antiviral is approved, agents like leflunomide, cidofovir, quinolones, and IVIg have been utilized.
- Retransplantation following BKV nephropathy has demonstrated successful outcomes.
Conclusions:
- BK virus (BKV) nephropathy remains a critical concern in kidney transplantation, intricately linked to immunosuppression levels.
- Early detection and proactive management, including judicious immunosuppression adjustment and supportive therapies, are key to preserving allograft function.
- Despite treatment challenges, retransplantation offers a viable option for patients experiencing BKV-related graft loss.
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