BK Polyomavirus-associated nephropathy - diagnostic and treatment standard
A treatment-standard review of BK polyomavirus nephropathy after kidney transplantation outlines why reducing immunosuppression remains the mainstay despite rejection risk, the limits of biopsy and viral-load testing, and emerging antibody and cell-based therapies.
Background
BK polyomavirus is a significant viral complication of kidney transplantation. Prompt immunosuppression reduction lowers early graft failure from BK polyomavirus-associated nephropathy (BKPyVAN), but modulating immunosuppression can precipitate acute rejection, and medium-to-long-term graft outcomes are negatively affected.
Diagnosis
Kidney biopsy remains the gold-standard diagnostic test but false negatives are common due to the focal nature of BKPyVAN. BK DNAemia by quantitative PCR is the established screening test, but there is no international standardization of assays to allow comparison between centers.
Treatment and future directions
Randomized trials are lacking for both optimal immunosuppression-reduction strategies and the medications variably used in practice. Insights into adaptive immunity are informing novel treatments such as adoptive immunotherapies and neutralizing antibodies that still require evaluation in clinical studies.
Category
Transplant
Source
Nephrology Dialysis Transplantation
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