Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Newcastle Transplant Unit, John Hunter Hospital, Newcastle, NSW, Australia.
Transplantation. 2022 Jan 1;106(1):e76-e89. doi: 10.1097/TP.0000000000003801.
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.
多瘤病毒 BK 病毒（BKPyV）感染是肾移植和移植物失功的重要并发症。病毒血症的患病率为 10%-15%，而 BKPyV 相关性肾病（BKPyVAN）为 3%-5%。鉴于目前尚无针对 BKPyVAN 的有效抗病毒预防或治疗策略，建议积极筛查 BKPyV 病毒血症，特别是在移植后早期。减少免疫抑制以允许病毒清除可能避免进展为严重和不可逆转的移植物损伤。由于证据主要依赖于观察性数据，因此移植中心之间筛查的频率和持续时间存在很大差异。虽然主要的治疗目标集中在通过减少免疫抑制来实现病毒清除，但预防随后的急性排斥反应、提前移植物丢失和恢复透析仍然是主要挑战。BKPyV 感染的治疗策略应根据受者的基础免疫风险和移植物感染的严重程度个体化。辅助治疗（包括静脉注射免疫球蛋白和更昔洛韦）的疗效数据很少。需要未来进行有足够效力和高质量的随机对照试验，为 BKPy 感染的管理提供循证临床实践依据。
