Current Status, Prevention and Treatment of BK Virus Nephropathy

Kurašová, Ester; Štěpán, Jakub; Krejčí, Karel; Mrázek, František; Sauer, Pavel; Janečková, Jana; Tichý, Tomáš

doi:10.14712/18059694.2023.1

Acta Medica > Archive > 2022, Vol. 65 > Issue 4 > Current Status, Prevention and Treatment…

Acta Med. 2022, 65: 119-124

https://doi.org/10.14712/18059694.2023.1

Current Status, Prevention and Treatment of BK Virus Nephropathy

Ester Kurašová^a

, Jakub Štěpán^a, Karel Krejčí^a, František Mrázek^b, Pavel Sauer^c, Jana Janečková^d, Tomáš Tichý^e

^aUniversity Hospital Olomouc and Palacký University Olomouc, Faculty of Medicine and Dentistry, Department of Internal Medicine III – Nephrology, Rheumatology and Endocrinology, Olomouc, Czech Republic
^bUniversity Hospital Olomouc and Palacký University Olomouc, Faculty of Medicine and Dentistry, Department of Immunology, Olomouc, Czech Republic
^cUniversity Hospital Olomouc and Palacký University Olomouc, Faculty of Medicine and Dentistry, Department of Microbiology, Olomouc, Czech Republic
^dUniversity Hospital Olomouc and Palacký University Olomouc, Faculty of Medicine and Dentistry, Department of Surgery II, Olomouc, Czech Republic
^eUniversity Hospital Olomouc and Palacký University Olomouc, Faculty of Medicine and Dentistry, Department of Clinical and Molecular Pathology, Olomouc, Czech Republic

Received June 12, 2022
Accepted January 19, 2023

All renal transplant recipients should undergo a regular screening for BK viral (BKV) viremia. Gradual reduction of immunosuppression is recommended in patients with persistent plasma BKV viremia for 3 weeks after the first detection, reflecting the presence of probable or suspected BKV-associated nephropathy. Reduction of immunosuppression is also a primary intervention in biopsy proven nephropathy associated with BKV (BKVN). Thus, allograft biopsy is not required to treat patients with BKV viremia with stabilized graft function. There is a lack of proper randomised clinical trials recommending treatment in the form of switching from tacrolimus to cyclosporin-A, from mycophenolate to mTOR inhibitors or leflunomide, or the additive use of intravenous immunoglobulins, leflunomide or cidofovir. Fluoroquinolones are not recommended for prophylaxis or therapy. There are on-going studies to evaluate the possibility of using a multi-epitope anti-BKV vaccine, administration of BKV-specific T cell immunotherapy, BKV-specific human monoclonal antibody and RNA antisense oligonucleotides. Retransplantation after allograft loss due to BKVN can be successful if BKV viremia is definitively removed, regardless of allograft nephrectomy.