Jaing Tang-Her, Wang Yi-Lun, Chang Tsung-Yen
Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33315, China.
Viruses. 2025 Sep 17;17(9):1256. doi: 10.3390/v17091256.
The reactivation of BK polyomavirus (BKPyV) during severe immunosuppression plays a crucial role in two significant syndromes observed in transplant recipients: BK polyomavirus-associated nephropathy (BKPyVAN) in kidney transplant patients and BK polyomavirus-associated hemorrhagic cystitis (BKPyV-HC) in hematopoietic cell transplant (HCT) recipients. This review aims to summarize the current understanding and lingering ambiguity by looking at three primary questions: (1) In cases with BKPyV-related illnesses in transplant patients, which diagnostic methods have the best track record of accuracy and success? (2) Which therapy approaches have the best track records of safety and efficacy in real-world clinical settings? (3) What can immunological research teach us about the development of future tailored treatments? Diagnosis involves the patient's appearance, ruling out other potential causes, and employing quantitative PCR to identify active viral replication in urine or plasma. BKPyV-HC can vary from self-limited hematuria to potentially fatal bleeding, while BKPyVAN may lead to loss and dysfunction of the allograft. Reducing immunosuppression remains the key aspect of treatment. However, the effectiveness of antivirals (such cidofovir and leflunomide) is not always the same, and supporting measures depend on the syndrome. Researchers are looking into new immunotherapies, such as virus-specific cytotoxic T cells. Due to the intricate viro-immunopathology and lack of defined treatment regimens, future initiatives should focus on prospective studies to establish validated thresholds, enhance management algorithms, and integrate immune surveillance into individualized therapy.
在严重免疫抑制期间，BK多瘤病毒（BKPyV）的重新激活在移植受者中观察到的两种重要综合征中起着关键作用：肾移植患者中的BK多瘤病毒相关性肾病（BKPyVAN）和造血细胞移植（HCT）受者中的BK多瘤病毒相关性出血性膀胱炎（BKPyV-HC）。本综述旨在通过审视三个主要问题来总结当前的认识和仍存在的模糊之处：（1）在移植患者中患有BKPyV相关疾病的病例中，哪些诊断方法具有最佳的准确性和成功记录？（2）在实际临床环境中，哪些治疗方法具有最佳的安全性和疗效记录？（3）免疫学研究能让我们对未来量身定制治疗的发展有哪些了解？诊断涉及患者的表现、排除其他潜在原因以及采用定量PCR来识别尿液或血浆中的活跃病毒复制。BKPyV-HC的表现可从自限性血尿到潜在致命性出血不等，而BKPyVAN可能导致同种异体移植物的丧失和功能障碍。降低免疫抑制仍然是治疗的关键方面。然而，抗病毒药物（如西多福韦和来氟米特）的有效性并不总是相同的，支持措施取决于综合征。研究人员正在研究新的免疫疗法，如病毒特异性细胞毒性T细胞。由于复杂的病毒免疫病理学和缺乏明确的治疗方案，未来的举措应侧重于前瞻性研究，以建立经过验证的阈值、改进管理算法，并将免疫监测纳入个体化治疗。
