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BK polyomavirus in solid organ transplantation—Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
Author(s) -
Hirsch Hans H.,
Randhawa Parmjeet S.
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13528
Subject(s) - medicine , immunosuppression , transplantation , leflunomide , bk virus , nephropathy , kidney transplantation , organ transplantation , tacrolimus , urology , mycophenolic acid , kidney , gastroenterology , surgery , endocrinology , methotrexate , diabetes mellitus
The present AST ‐ IDCOP guidelines update information on BK polyomavirus ( BKP yV) infection, replication, and disease, which impact kidney transplantation ( KT ), but rarely non‐kidney solid organ transplantation ( SOT ). As pretransplant risk factors in KT donors and recipients presently do not translate into clinically validated measures regarding organ allocation, antiviral prophylaxis, or screening, all KT recipients should be screened for BKP yV‐ DNA emia monthly until month 9, and then every 3 months until 2 years posttransplant. Extended screening after 2 years may be considered in pediatric KT . Stepwise immunosuppression reduction is recommended for KT patients with plasma BKP yV‐ DNA emia of >1000 copies/ mL sustained for 3 weeks or increasing to >10 000 copies/ mL reflecting probable and presumptive BKP yV‐associated nephropathy, respectively. Reducing immunosuppression is also the primary intervention for biopsy‐proven BKP yV‐associated nephropathy. Hence, allograft biopsy is not required for treating BKP yV‐ DNA emic patients with baseline renal function. Despite virological rationales, proper randomized clinical trials are lacking to generally recommend treatment by switching from tacrolimus to cyclosporine‐A, from mycophenolate to mTOR inhibitors or leflunomide or by the adjunct use of intravenous immunoglobulins, leflunomide, or cidofovir. Fluoroquinolones are not recommended for prophylaxis or therapy. Retransplantation after allograft loss due to BKP yV nephropathy can be successful if BKP yV‐ DNA emia is definitively cleared, independent of failed allograft nephrectomy.