Management of BK-virus infection – Swedish recommendations

Abstract

BK-virus (BKV) associated nephropathy (BKVAN) and BKV associated haemorrhagic cystitis (HC) are complications of BKV infection/reactivation in renal and allogeneic haematopoietic stem cell transplantation (HSCT) patients, respectively. The task of how to manage these diseases was given to the chair by the Swedish Reference Group for Antiviral Therapy (RAV). After individual contributions by members of the working group, consensus discussions were held in a meeting on 23 January 2018 arranged by RAV. Thereafter, the recommendations were published in Swedish on November 2018. The current translation to English has been approved by all co-authors. High BKV serum levels suggest an increased risk for BKVAN and potential graft failure. For detection of BKVAN, careful monitoring of BKV DNA levels in serum or plasma is recommended the first year after renal transplantation and when increased creatinine serum levels of unknown cause are observed. Notably, a renal biopsy is mandatory for diagnosis. To reduce the risk for progression of BKVAN, there is no specific treatment, and tailored individual decrease of immunosuppression is recommended. For BKV-HC, BKV monitoring is not recommended, since BK-viruria frequently occurs in HSCT patients and the predictive value of BKV in plasma/serum has not been determined. However, the risk for BKV-HC is higher for patients undergoing myeloablative conditioning, having an unrelated, HLA-mismatched, or a cord blood donor, and awareness of the increased risk and early intervention may benefit the patients. Also for BKV-HC, no specific therapy is available. Symptomatic treatment, e.g. forced diuresis and analgesics could be of use.

Incidence and Risk Factors for High-level BK Viruria -A Single Center Study in China

“…These reports reveal differences in the prevalence of BK virus infection in time and space. To be sure, the highest incidence of BK viruria in renal transplant recipients was within 6 months of surgery, in accordance with the other centers have reported [8] .…”

Urinary CCL2 and CXCL10 chemokines as potential biomarkers of ongoing pathological processes in kidney allograft: association with BK virus nephropathy

“…The usual strategy on identification of BKV is a gradual reduction of immunosuppression. 11,12 Currently, renal biopsy is the gold standard in the assessment of kidney function. 13 Protocol biopsies performed at 3 and 12 months postoperatively, as part of standard posttransplant management, are considered to be safe procedures with the risk rate of major complications from 0.33% to 1%.…”

<p>BK Virus Nephropathy: Prevalence, Impact and Management Strategies</p>

“…Most centers monitor BKV post-transplant at 3, 6, 9, and 12 months. 44 However, with more intense induction regimen or in those with risk factors, it is prudent to perform routine surveillance at monthly intervals in the first 12 months following transplant. This is standard in our center.…”