Pre-emptive management of polyomavirus BK in pediatric kidney transplant recipients
Original article
Ginevri F et al. (2007) Prospective monitoring of polyomavirus BK replication and impact of pre-emptive intervention in pediatric kidney recipients. Am J Transplant 7: 2727–2735 PubMed
Polyomavirus BK-associated nephropathy (PVAN) in renal allograft recipients is sometimes controlled through a reduction in the level of immunosuppression. Screening for BK viremia could identify patients at high risk of developing PVAN who might benefit from pre-emptive minimization of immunosuppression, but there is concern that early immunosuppression reduction will induce acute rejection.
A recent study investigated pre-emptive immunosuppression reduction in 62 pediatric kidney transplant recipients followed up for a median of 24 months. Polymerase chain reaction was used to detect BK virus in blood and urine samples taken at regular intervals after transplantation. Doses of maintenance immunosuppressants were tapered in a step-wise manner in viremic patients with increasing viral loads. Renal biopsies were performed to evaluate PVAN presence in viremic patients.
BK viruria was detected in 39 (63%) patients at a median of 3 months (range 1–24 months) after transplantation. BK viremia was detected in 13 (21%) patients at a median of 3 months (range 1–18 months) after transplantation. Pre-emptive reduction of immunosuppression resulted in viremia clearance in all 13 patients, taking a median of 2 months (range 1–8 months). Viruria was cleared in 12 of the 13 viremic patients during the study, taking a median of 8 months. At last follow-up, no PVAN had been detected. Pre-emptive immunosuppression tapering did not cause any cases of acute rejection.
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Subject areas under which this article appears: Transplant
