Acute Injury From BK Virus After Second Transplant Resulted in Rapid Graft Loss: A Case Report

The BK virus has become a substantial threat to transplanted kidneys. Yet, the present understanding of the clinical course and postoperative management of BK virus infections remains inadequate. Here, we report a case of a male transplant recipient with rapid graft loss due to BK virus-associated nephropathy after the second renal transplant, who had previously experienced failure of his first kidney allograft for the same reason. The posttransplant period was uneventful until serum creatinine rose to 2.30 mg/dL on postoperative day 59. Puncture biopsy was postponed because of swelling in the transplanted kidney, and acute rejection was considered as a source of the swelling because the repetitive results of blood BK virus DNA tests were negative. Methylprednisolone 500 mg was administered empirically for 3 days, followed by a 5-day course of anti-thymocyte globulin 100 mg. On postoperative day 83, SV40 T-antigen antibody immunostaining confirmed the diagnosis of BK virus nephropathy. However, it took only 28 days for this patient to progress from abnormal kidney function to the loss of the secondary transplanted kidney, and dialysis was initiated on postoperative day 87. To our knowledge, this is the first report of BK virus resulting in acute failure of a transplanted kidney. An early biopsy is crucial, and a negative test for viremia is not sufficient to exclude the recurrence of BK virus.