BK polyomavirus in solid organ transplantation.

Abstract

The human BK polyomavirus (BKV) is the major cause of polyomavirus-associated nephropathy (PyVAN) putting 1-15% of kidney transplant patients at risk of premature allograft failure, but is less common in other solid organ transplants. Because effective antiviral therapies are lacking, screening kidney transplant patients for BKV replication in urine and blood has become the key recommendation to guide the reduction of immunosuppression in patients with BKV viremia. This intervention allows for expanding BKV-specific cellular immune responses, curtailing of BKV replication in the graft, and clearance of BKV viremia in 70-90% patients. Postintervention rejection episodes occur in 8-12%, most of which are corticosteroid responsive. Late diagnosis is faced with irreversible functional decline, poor treatment response, and graft loss. Adjunct therapies such as cidofovir, leflunomide and intravenous immunoglobulins have been used, but the benefit is not documented in trials. Retransplantation after PyVAN is largely successful, but requires close monitoring for recurrent BKV viremia.

• Authors: H H Hirsch, P Randhawa, AST Infectious Diseases Community of Practice
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 13 Suppl 4 Pg. 179-88 (Mar 2013) ISSN: 1600-6143 [Electronic] United States
• PMID: 23465010 (Publication Type: Journal Article)
• Copyright: © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

Chemical References

• Antiviral Agents
• Immunosuppressive Agents

Topics

• Antiviral Agents (therapeutic use)
• BK Virus (isolation & purification, pathogenicity)
• Humans
• Immunosuppressive Agents (administration & dosage)
• Organ Transplantation
• Polyomavirus Infections (diagnosis, drug therapy, epidemiology, virology)
• Risk Factors
• Viral Load
• Virus Replication