First-time use of pathogen absorptive device in severe BK DNAemia/BK polyomavirus-associated nephropathy post kidney transplantation

Kyle A Merrill; Ruthellen H Anderson; David A Axelrod; Brynna Van Wyk; Lyndsay A Harshman

doi:10.1007/s00467-026-07419-y

Back

First-time use of pathogen absorptive device in severe BK DNAemia/BK polyomavirus-associated nephropathy post kidney transplantation

Journal article

Open access

Peer reviewed

First-time use of pathogen absorptive device in severe BK DNAemia/BK polyomavirus-associated nephropathy post kidney transplantation

Kyle A Merrill, Ruthellen H Anderson, David A Axelrod, Brynna Van Wyk and Lyndsay A Harshman

Pediatric nephrology (Berlin, West)

06/24/2026

DOI: 10.1007/s00467-026-07419-y

PMID: 42340438

Appears in UI Libraries Support Open Access

Files and links (1)

url

https://doi.org/10.1007/s00467-026-07419-yView

Published (Version of record) Open Access

Abstract

BK polyomavirus (BKPyV)-associated nephropathy in kidney transplant recipients is an important cause of allograft dysfunction and premature allograft failure. Treatment options for BKPyV-DNAemia following kidney transplantation remain limited. Adjunctive pathogen adsorption devices such as the Seraph® 100 Microbind® Affinity Blood Filter (Seraph® 100) have previously been used for clearance of viruses, bacteria, and toxins in critical illness under FDA Emergency Use Authorization. An 18-year-old recipient of a deceased donor kidney transplant developed severe BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy refractory to reduced immunosuppression, antiviral therapy, and adjunctive intravenous immunoglobulin (IVIG). Given progressive allograft dysfunction, consideration was given to adjunctive extracorporeal therapies targeting BKPyV-DNAemia removal. Despite multiple interventions including reduction of immunosuppression, cidofovir, leflunomide, and IVIG, BKPyV-DNAemia continued to worsen with levels reaching approximately 2 million copies/mL by 7 months post-transplant. The patient developed de novo donor-specific antibodies and biopsy-proven antibody-mediated rejection concurrent with BKPyV-nephropathy and rising serum creatinine. Within 8 weeks of Seraph® treatment, BKPyV-DNA levels resolved to < 5000 copies/mL. During the subsequent 12-month follow-up period, her graft function stabilized with serum creatinine of 1.2-1.3 mg/dL without proteinuria and stable class II DSA. The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation (TTS 2024) [1] BK polyomavirus in solid organ transplantation - Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice (AST-IDCOP 2019) [2].

Pediatrics

BK polyomavirus-associated nephropathy

Kidney transplant

Pathogen adsorption

Affinity blood filter

BKPyV-DNAemia

UIOWA OA Agreement

Details

Title: Subtitle: First-time use of pathogen absorptive device in severe BK DNAemia/BK polyomavirus-associated nephropathy post kidney transplantation
Creators: Kyle A Merrill - University of Iowa
Ruthellen H Anderson - University of Iowa
David A Axelrod - University Hospitals of Cleveland
Brynna Van Wyk - University of Iowa
Lyndsay A Harshman - University of Iowa
Resource Type: Journal article
Publication Details: Pediatric nephrology (Berlin, West)
DOI: 10.1007/s00467-026-07419-y
PMID: 42340438
NLM abbreviation: Pediatr Nephrol
ISSN: 1432-198X
eISSN: 1432-198X
Publisher: Springer Nature
Language: English
Electronic publication date: 06/24/2026
Academic Unit: Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics; Iowa Neuroscience Institute
Record Identifier: 9985176647002771

Metrics

2 Record Views