Acta Med. 2022, 65: 119-124
Current Status, Prevention and Treatment of BK Virus Nephropathy
, Jakub Štěpána, Karel Krejčía, František Mrázekb, Pavel Sauerc, Jana Janečkovád, Tomáš Tichýe
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.
Keywords
BK virus nephropathy, BK virus-specific T-cell immunotherapy, monoclonal anti-BK virus antibodies, BK virus vaccine, immunosuppressive therapy, RNA antisense oligonucleotides, kidney transplantation.
Funding
This study was supported by MH CZ – DRO (FNOI, 00098892) and grant IGA_LF_2022_003.
References
Copyright
This is an open-access article distributed under the terms of the Creative Commons Attribution License.
