BK Virus: A Cause for Concern in Thoracic Transplantation?

Area of Science:

• Transplantation immunology
• Virology
• Nephrology

Background:

• Human BK polyomavirus (BKV) infection is under-documented in thoracic transplant recipients.
• While BKV viruria and viremia occur, progression to BKV-associated nephropathy (BKVN) seems less frequent than in kidney transplant patients.
• Reported BKVN cases in heart and lung recipients often present late with poor outcomes.

Purpose of the Study:

• To review the current understanding of BK polyomavirus infection in heart and lung transplant recipients.
• To identify risk factors and outline diagnostic and management strategies for BKV infection in this population.

Main Methods:

• Literature review of BKV infection in thoracic transplantation.
• Analysis of reported cases and risk factors.
• Comparison with BKV infection patterns in kidney transplantation.

Main Results:

• BK viruria affects approximately 19% and viremia 5% of heart transplant recipients; data for lung recipients are limited.
• Risk factors may include cytomegalovirus infection and immunosuppressive therapy.
• BKVN is infrequent but associated with poor outcomes, suggesting late diagnosis.

Conclusions:

• Routine BKV surveillance is not recommended for thoracic transplant patients due to low incidence.
• Diagnostic workup for BKV is justified in cases of unexplained renal dysfunction, post-immunosuppression therapy, or co-existing conditions like CMV infection or hypogammaglobulinemia.
• Treatment follows kidney transplant protocols, emphasizing tailored immunosuppression reduction for thoracic transplant recipients.