Jorge C. Garces , MD. Author information Article notes Copyright and License information Disclaimer. Keywords: BK virus, complication of kidney transplant, polyomavirus.
This article has been cited by other articles in PMC. Nasopharyngeal aspirate obtained from infants with respiratory infections. Renal transplant. HLA antigen mismatches. Rejection and antirejection treatment. BK virus—seronegative recipients. BK virus—seropositive donors. HLA-C7—negative donor, negative recipient. Randhawa P. BK virus infection in transplant recipients: an overview and update. Am J Transplant. Hirsch H. Polyomavirus-associated nephropathy in renal transplantation: interdisciplinary analyses and recommendations.
Comoli P. Polyomavirus-associated nephropathy: update on BK virus-specific immunity. Transpl Infect Dis. Mischitelli M. Complications post renal transplantation: literature focus on BK virus nephropathy and diagnostic tools actually available. Virol J. Brennan D. Incidence of BK with tacrolimus versus cyclosporine and impact of preemptive immunosuppression reduction [published correction appears in Am J Transplant.
Beimler J. The influence of immunosuppression on the development of BK virus nephropathy—does it matter? Nephrol Dial Transplant. Cosio F. Comparison of low versus high tacrolimus levels in kidney transplantation: assessment of efficacy by protocol biopsies. Drachenberg C. Histological patterns of polyomavirus nephropathy: correlation with graft outcome and viral load.
Bohl D. BK virus nephropathy and kidney transplantation. Clin J Am Soc Nephrol. Polyomavirus-associated nephropathy: update in diagnosis. DeMay R. The Art and Science of Cytopathology. Vol 1. Viscount H. Polyomavirus polymerase chain reaction as a surrogate marker of polyomavirus-associated nephropathy. Pang X. Monitoring of polyoma BK viruria and viremia in renal allograft recipients using quantitative real-time PCR assay: one-year prospective study.
J Clin Microbiol. Does reduction in immunosuppression in viremic patients prevent BK virus nephropathy in de novo renal transplant recipients? A prospective study. Prospective study of polyomavirus type BK replication and nephropathy in renal transplant recipients. New Engl J Med.
Wali R. Intensive versus routine care screening for polyoma viral reactivation cluster randomization and a road map for stepwise modification of immunosuppression therapy IT Am J Transplant. Table 2 Clinical trials for HC. Conservative therapy Conservative therapies, also known as supportive approaches or symptomatic therapies, are considered as preventive and the first steps of therapy in most centers.
Complimentary options In more severe cases grades 2 and 3 HC , complimentary options described below are used: - Optimization of the hematological homeostasis including the use of clotting factors recombinant factor VIIa or VIII, factor XIII and antifibrinolytic agent aminocapronic acid [ 6 , 11 ].
Surgical procedures In very severe cases, as last step of treatment, urological intervention and surgical management such as bilateral percutaneous nephrostomy tubes with or without ureteral occlusion, selective arterial embolization, cauterization, fulguration and total or partial cystectomy should be considered [ 6 , 11 , 49 ].
Pharmacological treatments Currently, there are no specific antiviral treatments with strong evidence of clinical efficacy against BKV.
Adoptive cell therapy Although pharmacological therapies and prophylactic options are available to treat viral infections, they remain limited and ineffective due in part to drug resistance, drug related toxicities and morbidities notably acute kidney injury and myelosuppression [ 1 , 78 , 79 ].
VSTs The preliminary practices of adoptive T cell transfer were based on nonspecific donor lymphocyte infusions DLIs which led to restoring antiviral immunity with promising results. Table 3 Different methods for generation of VST. Ultimately expansion of T cells using IL Different practices for the generation of multivirus-specific T cells in one single step have been established.
Third-party VST can be utilize for these patients. Mesenchymal stromal cells In recent years, Mesenchymal stromal cells MSCs have captured significant interest in regenerative medicine because of their potential immunomodulatory effects, low immunogenicity and wound healing abilities [ 89 , 90 ].
Disclosure of conflict of interest None. References 1. Adoptive T cell therapystrategies for viral infections in patients receiving haematopoietic stem cell transplantation. Houghtelin A, Bollard CM. Virus-specific T cells for the immunocompromised patient. Front Immunol.
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Brincidofovir: understanding its unique profile and potential role against adenovirus and other viral infections. Future Microbiol. Management of BK-virus infection-Swedish recommendations. Infect Dis Lond ; 51 — Routine screening for BK has been shown to be effective in preventing allograft loss in patients with BK viruria or viremia. Reduction of immunosuppression remains the mainstay of BK nephropathy treatment and is the best studied intervention.
In this review, we will discuss the epidemiology of BK virus infection, screening strategies, treatment options and future research directions.
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