title: Perception, diagnosis and management of BK polyomavirus replication and disease in paediatric kidney transplant recipients in Europe.
abstract: BK polyomavirus (BKPyV)-associated nephropathy remains a challenge to the success of kidney transplantation, but its impact varies in different transplant programmes.
  
  
  
  We investigated current practice through a web-based questionnaire made available by the European Society for Paediatric Nephrology (ESPN).
  
  
  
  A total of 90 physicians (23% of 391 active members) from 27 countries participated in the study. BKPyV-associated nephropathy is seen in 1-5% of patients annually with treatment success in 30-60%, and graft loss in 10%. Quantitative BKPyV load testing is available to >90% of physicians. Screening is performed in urine alone in 26%, in urine and blood in 37% and in blood alone in 37%. Most physicians (47%) screen at month 1, 2, 3, 6, 9 and 12 post-transplant. For patients with baseline renal function and plasma BKPyV loads of 10 000-1 000 000 copies/mL, 50% report performing renal biopsies prior to intervention. Intervention consists of reducing immunosuppression first with mycophenolate (Myc) in 40%, first with calcineurin inhibitors (CNI) in 29% or with both in 31%. Changing immunosuppressive drugs is considered mainly for biopsy-proven nephropathy consisting of discontinuation of Myc in 75%, and switching from CNI to mTOR inhibitors (52%). Cidofovir, intravenous immunoglobulin G, leflunomide and fluoroquinolones are used in less than one-third of this group. Furthermore, 66% of participants see a need for new antiviral drugs and new immmunosuppressive strategies, and almost 90% are willing to participate in future observational and interventional trials.
  
  
  
  This ESPN survey suggests that prompt translation of a positive screening test into reducing immunosuppression could improve outcomes.
authors.affiliation: Department of Paediatric Nephrology, Hannover Medical School, Hannover, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Pape
authors.affiliation: Department of Paediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Tönshoff
authors.affiliation: Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland Infection Diagnostics, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland Infectious Disease & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Hans H
authors.initials: HH
authors.lastname: Hirsch
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D001739:BK Virus / Q000187:drug effects* / Q000276:immunology / Q000472:pathogenicity; D002648:Child; D019468:Disease Management; D005060:Europe; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D010465:Perception; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents
keywords: BK polyomavirus; immunosuppression; screening; survey; treatment