The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation.
The Second International Consensus Guidelines on BK polyomavirus (BKPyV) in kidney transplantation, developed using GRADE, reaffirm monthly plasma BKPyV-DNAemia screening with stepwise immunosuppression reduction as the cornerstone of management, and do not support routine use of antiviral or adjunctive agents.
Background
BK polyomavirus remains a significant challenge after kidney transplantation and a cause of allograft dysfunction and loss. International experts reviewed current evidence and updated recommendations according to the GRADE framework. Risk factors for BKPyV-DNAemia and biopsy-proven nephropathy include older recipient age, male sex, donor BKPyV-viruria, seropositive donor with seronegative recipient, tacrolimus, acute rejection, and higher steroid exposure.
Key recommendations
All kidney transplant recipients should be screened monthly for plasma BKPyV-DNAemia until month 9, then every 3 months until 2 years post-transplant (3 years for children). For patients with DNAemia persisting above 1000 copies/mL, exceeding 10,000 copies/mL, or with biopsy-proven nephropathy, immunosuppression should be reduced in predefined steps targeting antiproliferative drugs, calcineurin inhibitors, or both. In resource-limited settings, urine cytology screening can exclude nephropathy. Immunohistochemistry is preferred for diagnosing biopsy-proven BKPyV-nephropathy.
Clinical implications
Routine screening is described as cost-effective and improves clinical outcomes and quality of life. Re-transplantation after BKPyV-nephropathy is feasible in eligible recipients if DNAemia is undetectable, and routine graft nephrectomy is not recommended. Current evidence does not support use of leflunomide, cidofovir, quinolones, or IVIG; patients considered for experimental treatments such as antivirals, vaccines, neutralizing antibodies, or adoptive T cells should be enrolled in clinical trials.
Category
Transplant
Source
Transplantation
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