BKPyVAN is a vital cause of allograft loss after KTx. Re-Tx is NOT CI with previous graft loss related to BKPyVAN, but data about clinical outcome are
BKPyVAN is a vital cause of allograft loss after KTx. Re-Tx is NOT CI with previous graft loss related to BKPyVAN, but data about clinical outcome are scarce. A case-control study compared about 350 re-Tx ptns with history of graft loss related to BKPyVAN with > 13,000 ptns developed graft loss owing to other causes showed no differences in the rate of 5-y allograft survival, acute rejection, or one-y ptn survival after re-Tx. Conclusion: re-Tx after graft loss related to BKPyVAN is accepted with a generally reported good outcome.
Leeaphorn N, Thongprayoon C, Chon WJ, et al. Outcomes of kidney retransplantation after graft loss as a result of BK virus nephropathy in the era of newer immunosuppressant agents. Am J Transplant 2020; 20: 1334.
BKPyV: a small DNA virus establishing lifelong infection within renal tubular & uro-epithelial cells of mostly whole world. BK infection is usually benign. However, in im/m. ptns, BKPyV my reactivate > clinically evident disease. In kidney TR, BKPyV-related disease typically seen in the early post-tx period when im/m. dosage is mostly intense. Other factors related to BKPyV disease include:
1) High-risk sero-setting (i.e., BK sero+ve donor to sero-ve recipient),
2) Donor immune response to BKPyV, &
3) Donor BKPyV viruria prior to tx
1) Monthly for 1st 6 mo, 3 monthly until 2 y., then annually 5 ys post-tx.
2) With allograft dysfunction or with biopsy for allograft dysfunction.
Allograft biopsy is the for BKPyVAN Dgx, evaluating its intensity, & associated processes. Nevertheless, as biopsy is an invasive process & sampling error is possible, a presumptive Dgx is usually made according to significance of viremia (viral copies/mL). Graft rejection may simulate BKPyVAN on graft biopsy. DD, however, BKPyVAN from rejection is crucial as ttt for presumptive rejection with augmenting im/m. may result in graft loss if BKPyVAN is underlying. Moreover, may be simultaneously exist in biopsy, despite this is controversial.