Journal article
The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation
Transplantation, Vol.108(9), pp.1834-1866
04/12/2024
DOI: 10.1097/TP.0000000000004976
PMCID: PMC11335089
PMID: 38605438
Abstract
BK polyomavirus (BKPyV) remains a significant challenge after kidney transplantation. International experts reviewed current evidence and updated recommendations according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Risk factors for BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy include recipient older age, male sex, donor BKPyV-viruria, BKPyV-seropositive donor/-seronegative recipient, tacrolimus, acute rejection, and higher steroid exposure. To facilitate early intervention with limited allograft damage, all kidney transplant recipients should be screened monthly for plasma BKPyV-DNAemia loads until month 9, then every 3 mo until 2 y posttransplant (3 y for children). In resource-limited settings, urine cytology screening at similar time points can exclude BKPyV-nephropathy, and testing for plasma BKPyV-DNAemia when decoy cells are detectable. For patients with BKPyV-DNAemia loads persisting >1000 copies/mL, or exceeding 10 000 copies/mL (or equivalent), or with biopsy-proven BKPyV-nephropathy, immunosuppression should be reduced according to predefined steps targeting antiproliferative drugs, calcineurin inhibitors, or both. In adults without graft dysfunction, kidney allograft biopsy is not required unless the immunological risk is high. For children with persisting BKPyV-DNAemia, allograft biopsy may be considered even without graft dysfunction. Allograft biopsies should be interpreted in the context of all clinical and laboratory findings, including plasma BKPyV-DNAemia. Immunohistochemistry is preferred for diagnosing biopsy-proven BKPyV-nephropathy. Routine screening using the proposed strategies is cost-effective, improves clinical outcomes and quality of life. Kidney retransplantation subsequent to BKPyV-nephropathy is feasible in otherwise eligible recipients if BKPyV-DNAemia is undetectable; routine graft nephrectomy is not recommended. Current studies do not support the usage of leflunomide, cidofovir, quinolones, or IVIGs. Patients considered for experimental treatments (antivirals, vaccines, neutralizing antibodies, and adoptive T cells) should be enrolled in clinical trials.
Details
- Title: Subtitle
- The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation
- Creators
- Camille N Kotton - Harvard Medical SchoolNassim Kamar - Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University Paul Sabatier, Toulouse, FranceDavid Wojciechowski - The University of Texas Southwestern Medical CenterMichael Eder - Medical University of ViennaHelmut Hopfer - University Hospital of BaselParmjeet Randhawa - University of PittsburghMartina Sester - Saarland UniversityPatrizia Comoli - Cell Factory and Pediatric Hematology/Oncology Unit, Department of Mother and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, ItalyHelio Tedesco Silva - Universidade de São PauloGreg Knoll - University of OttawaDaniel C Brennan - Johns Hopkins UniversityJennifer Trofe-Clark - University of PennsylvaniaLars Pape - University of Duisburg-EssenDavid Axelrod - University of IowaBryce Kiberd - Dalhousie UniversityGermaine Wong - Westmead HospitalHans H Hirsch - University Hospital of BaselTransplantation Society International BK Polyomavirus Consensus Group
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.108(9), pp.1834-1866
- DOI
- 10.1097/TP.0000000000004976
- PMID
- 38605438
- PMCID
- PMC11335089
- NLM abbreviation
- Transplantation
- ISSN
- 0041-1337
- eISSN
- 1534-6080
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Language
- English
- Electronic publication date
- 04/12/2024
- Academic Unit
- Surgery
- Record Identifier
- 9984585056502771
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