Pre-transplant immune factors may be associated with BK polyomavirus reactivation in kidney transplant recipients

DeWolfe, David; Gandhi, Jinal; Mackenzie, Matthew R.; Broge, Thomas; Bord, Evelyn; Babwah, Amaara; Mandelbrot, Didier A.; Pavlakis, Martha; Cardarelli, Francesca; Viscidi, Raphael P.; Chandraker, Anil; Tan, Chen

doi:10.1371/journal.pone.0177339

Cited by 16 publications

(21 citation statements)

References 53 publications

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“…Patients with BK viremia were found to have lower CD4, higher total CD8 proportions on pre-transplant samples, when compared to patients who did not develop BK viremia. 24 Patients with more polyfunctional CD8+ T cells expressing multiple cytokines were more likely to clear BK infections within 3 months. 25 Bohl et al studied urine samples from 20 recipient pairs of a deceased kidney transplant.…”

Section: Epidemiologymentioning

confidence: 98%

<p>BK virus in transplant recipients: current perspectives</p>

Muhsin

Wojciechowski

2019

TRRM

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Since its discovery in 1971, BK Polyomavirus infection has been increasingly recognized, especially since the introduction of more effective immunosuppressive medications in the early 1990s. BK virus is believed to have a high seroprevalence in healthy individuals, entering a latent phase in the genitourinary that follows the primary infection. Reactivation may occur in immunocompromised hosts, with significant effects seen especially in kidney and hematopoietic stem cell transplant recipients. Screening methods have been developed and are implemented as early detection may allow for the prevention of irreversible tissue damage. Reduction of immunosuppression remains the cornerstone of therapy for BKV infection, and adjunctive therapies have shown variable results. Newer cellular-based therapeutics might provide a more targeted treatment for BKV infection but are still in need of more randomized human studies.

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Section: Epidemiologymentioning

confidence: 98%

<p>BK virus in transplant recipients: current perspectives</p>

Muhsin

Wojciechowski

2019

TRRM

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“…An important role in the development of BKVN may also play the pre-transplant T-cell phenotype. Low blood CD4 and an increased number of effector CD8 cells were found in patients with BKV viraemia occurring after kidney transplantation, where this phenotype is characteristic of immune system weakening 18 .…”

Section: T Cell Responsementioning

confidence: 99%

BK virus-induced renal allograft nephropathy

Krejčí¹,

Tichý²,

Bednaříková³

et al. 2018

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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BK virus nephropathy (BKVN) is a serious opportunistic infection threatening renal function especially during the first year after transplantation. Its incidence is now on the rise and is closely related to the level of the recipient's immune system inhibition. This is more intensive with current trends in transplantation medicine, where more potent immunosuppressive protocols are used and more aggressive antirejection therapy is applied. In the absence of BK virus (BKV) specific therapy and limited treatment options for advanced BKVN, active screening of BKV replication and subsequent preemptive adjustment of immunosuppression are essential measures to prevent BKVN. However, it remains unclear how to modify immunosuppressive protocols as well as how to address initial stages of BKV replication. This comprehensive review summarizes the currently applied and not completely uniform procedures for the detection, prophylaxis and therapy of BKV replication and BKVN. The pitfalls brought by reduced immunosuppression, as a typical response to a significant viral replication or a developed BKVN, are also mentioned, particularly in the form of graft rejection. The paper also outlines the authors' experiences, and lists currently ongoing studies on the subject. The perspectives of new, especially immune-based, procedures in the treatment of complications associated with BKV infections are highlighted. Different views on the management of patients indicated for kidney re-transplantation whose previous graft failed because of BKVN are also discussed.

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“…Other risk factors identified in kidney transplant patients could potentially apply equally to non-renal transplantation, such as low or no BKV-specific T-cell responses or antibody titers, the potency of immunosuppression, anti-rejection therapy and cytomegalovirus (CMV) infection [ 5 , 60 – 62 ]. Impaired immune surveillance by CD8 and CD4 T-lymphocytes is, as would be expected, a clear risk factor [ 63 , 64 ], and previous humoral immunity may be protective. There is evidence that BKV-seronegative children are more likely to progress to BKVN after kidney transplantation [ 65 , 66 ].…”

Section: Risk Factors For Bk Infection and Bkvn In Thoracic Transplanmentioning

confidence: 99%

BK Virus: A Cause for Concern in Thoracic Transplantation?

Barten

Zuckermann

2018

Ann Transplant

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Human BK polyomavirus (BKV) infection is poorly documented in heart and lung transplant patients. BK viruria and viremia have been estimated to affect 19% and 5% of heart transplant recipients, respectively. Data are limited, especially for lung transplantation, but the proportion of patients progressing from BK viruria to viremia or BKV-related nephropathy (BKVN) appears lower than in kidney transplantation. Nevertheless, a number of cases of BKVN have been reported in heart and lung transplant patients, typically with late diagnosis and generally poor outcomes. Risk factors for BKV infection or BKVN in this setting are unclear but may include cytomegalovirus infection and anti-rejection treatment. The relative infrequency of BKVN or other BK-related complications means that routine BKV surveillance in thoracic transplantation is not warranted, but a diagnostic workup for BKV infection may be justified for progressive renal dysfunction with no readily-identifiable cause; after anti-rejection therapy; and for renal dysfunction in patients with cytomegalovirus infection or hypogammaglobulinemia. Treatment strategies in heart or lung transplant recipients rely on protocols developed in kidney transplantation, with reductions in immunosuppression tailored to match the higher risk status of thoracic transplant patients.

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Pre-transplant immune factors may be associated with BK polyomavirus reactivation in kidney transplant recipients

Cited by 16 publications

References 53 publications

<p>BK virus in transplant recipients: current perspectives</p>

<p>BK virus in transplant recipients: current perspectives</p>

BK virus-induced renal allograft nephropathy

BK Virus: A Cause for Concern in Thoracic Transplantation?

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