医学
免疫抑制
病毒血症
BK病毒
西多福韦
肾移植
透析
免疫学
移植
重症监护医学
内科学
病毒
作者
Thida Myint,Chanel H. Chong,Melanie Wyld,Brian J. Nankivell,Kathy Kable,Germaine Wong
出处
期刊:Transplantation
[Ovid Technologies (Wolters Kluwer)]
日期:2021-04-27
卷期号:106 (1): e76-e89
被引量:17
标识
DOI:10.1097/tp.0000000000003801
摘要
Polyomavirus BK virus (BKPyV) infection is an important complication of kidney transplantation and allograft failure. The prevalence of viremia is 10%–15%, compared with BK-associated nephropathy (BKPyVAN) at 3%–5%. Given that there are no effective antiviral prophylaxis or treatment strategies for BKPyVAN, active screening to detect BKPyV viremia is recommended, particularly during the early posttransplant period. Immunosuppression reduction to allow viral clearance may avoid progression to severe and irreversible allograft damage. The frequency and duration of screening are highly variable between transplant centers because the evidence is reliant largely on observational data. While the primary treatment goals center on achieving viral clearance through immunosuppression reduction, prevention of subsequent acute rejection, premature graft loss, and return to dialysis remain as major challenges. Treatment strategies for BKPyV infection should be individualized to the recipient’s underlying immunological risk and severity of the allograft infection. Efficacy data for adjuvant therapies including intravenous immunoglobulin and cidofovir are sparse. Future well-powered and high-quality randomized controlled trials are needed to inform evidence-based clinical practice for the management of BKPy infection.
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