BK Virus in Kidney Transplant: Current Concepts, Recent Advances, and Future Directions.
BK virus nephropathy is a challenging clinical problem in kidney transplant recipients with wide range of surveillance and management practices, based on individual experience. BK virus reactivation in kidney transplant recipients can result in BK virus nephropathy and graft loss. The most effective strategy for early diagnosis and treatment of BK virus nephropathy is regular monitoring for BK virus, currently achieved by quantification of viral DNA in blood by quantitative polymerase chain reaction. Immunosuppression reduction remains the mainstay of treatment; however, viral clearance is often followed by acute rejection, likely secondary to a delay between immune reconstitution and viral clearance. Impaired cell-mediated immune response to BK virus has been shown to correlate with progression to BK virus nephropathy, while reconstitution of this response correlates with resolution of nephropathy. There is recent research to support monitoring BK virus-specific cell-mediated immune response as a predictor of disease progression and resolution. In this article, we review the current concepts and recent developments in understanding BK virus-associated disease in the context of kidney transplant and outline areas for future research.
From the Department of Surgery, State University of New York, Buffalo, New York, USA.
Rajeev
R
Sharma
Stephanie
S
Tzetzo
Sunil
S
Patel
Mareena
M
Zachariah
Sonakshi
S
Sharma
Thomas
T
Melendy
D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus / Q000187:drug effects / Q000276:immunology* / Q000472:pathogenicity; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D054884:Host-Pathogen Interactions; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D012307:Risk Factors; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D014775:Virus Activation
D000998:Antiviral Agents; D007166:Immunosuppressive Agents