After pediatric kidney transplantation BK polyomavirus (BKPyV) infections are associated with an increased risk of graft loss by BKPyV-associated nephropathy (BkPyVAN). However, suitable prognostic markers for the individual outcome of BKPyV infections are missing and the management of therapeutic interventions remains a challenge to the success of pediatric kidney transplantation. This review gives an overview on current diagnostic and therapeutic strategies in the field of BKPyV infections after pediatric kidney transplantation. Methods determining the individual immune response to BKPyV are described and their usability is discussed. There is growing evidence that BKPyV-specific T cells (BKPyV-Tvis) may serve as prognostic markers in order to steer immunosuppressive therapy in pediatric kidney recipients with BKPyV viremia in future. Prospective randomized trials in viremic kidney recipients comparing Tvis-steered therapeutic intervention with standard reduction of immunosuppression are needed before implementation of BKPyV-Tvis monitoring in routine care of BKPyV infections.

中文翻译：

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小儿肾脏移植后BK多瘤病毒感染的诊断，治疗和免疫反应。

小儿肾脏移植后，BK多瘤病毒（BKPyV）感染与BKPyV相关性肾病（BkPyVAN）引起的移植物丢失风险增加相关。然而，缺少针对BKPyV感染个体结果的合适预后标志物，治疗干预的管理仍然是小儿肾脏移植成功的挑战。这篇综述概述了小儿肾脏移植后BKPyV感染领域的当前诊断和治疗策略。描述了确定针对BKPyV的个体免疫应答的方法，并讨论了其可用性。越来越多的证据表明，BKPyV特异性T细胞（BKPyV-Tvis）可以作为预后标志物，以指导将来对患有BKPyV病毒血症的小儿肾脏接受者进行免疫抑制治疗。