Nourie Nicole, Boueri Céline, Tran Minh Hoang, Divard Gillian, Lefaucheur Carmen, Salmona Maud, Gressens Simon B, Louis Kevin
Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, 75010 Paris, France.
Human Immunology and Immunopathology, Inserm UMR 976, Université Paris Cité, 75010 Paris, France.
Int J Mol Sci. 2024 Nov 28;25(23):12801. doi: 10.3390/ijms252312801.
BK polyomavirus (BKPyV) infection of the kidney graft remains a major clinical issue in the field of organ transplantation. Risk factors for BKPyV-associated nephropathy (BKPyVAN) and molecular tools for determining viral DNA loads are now better defined. BKPyV DNAemia in plasma, in particular, plays a central role in diagnosing active infection and managing treatment decisions. However, significant gaps remain in the development of reliable biomarkers that can anticipate BKPyV viremia and predict disease outcomes. Biomarkers under active investigation include urine-based viral load assays, viral antigen detection, and immune responses against BKPyV, which may offer more precise methods for monitoring disease progression. In addition, treatment of BKPyVAN is currently based on immunosuppression minimization, while the role of adjunctive therapies remains an area of active research, highlighting the need for more personalized treatment regimens. Ongoing clinical trials are also exploring the efficacy of T-cell-based immunotherapies. The clinical management of BKPyV infection, based on proactive virological monitoring, immune response assessment, integrated histopathology, and timely immunosuppression reduction, is likely to reduce the burden of disease and improve outcomes in kidney transplantation.
肾移植受者的BK多瘤病毒（BKPyV）感染仍是器官移植领域的一个主要临床问题。目前，BK多瘤病毒相关性肾病（BKPyVAN）的危险因素以及用于确定病毒DNA载量的分子工具已得到更好的界定。特别是血浆中的BKPyV病毒血症，在诊断活动性感染和指导治疗决策方面发挥着核心作用。然而，在开发能够预测BKPyV病毒血症并预测疾病转归的可靠生物标志物方面，仍存在重大差距。正在积极研究的生物标志物包括基于尿液的病毒载量检测、病毒抗原检测以及针对BKPyV的免疫反应，这些可能为监测疾病进展提供更精确的方法。此外，目前BKPyVAN的治疗基于尽量减少免疫抑制，而辅助治疗的作用仍是一个积极研究的领域，这凸显了需要更个性化的治疗方案。正在进行的临床试验也在探索基于T细胞的免疫疗法的疗效。基于主动病毒学监测、免疫反应评估、综合组织病理学以及及时减少免疫抑制的BKPyV感染临床管理，可能会减轻疾病负担并改善肾移植的预后。
