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Diagnostics, treatment, and immune response in BK polyomavirus infection after pediatric kidney transplantation

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Abstract

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.

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Abbreviations

BKPyV:

BK polyomavirus

BKPyVAN:

BK polyomavirus-associated nephropathy

CMV:

Cytomegalovirus

CsA:

Cyclosporine A

EBV:

Epstein Barr virus

ELISpot:

Enzyme-linked immunospot

IVIG:

Intravenous immunoglobulin

mTOR:

Mammalian target of rapamycin

PCR:

Polymerase chain reaction

TAC:

Tacrolimus

Tvis:

Virus-specific T cells

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Acknowledgements

We thank Jan Hinrich Bräsen, Department of Pathology, Hanover Medical School, for providing Figure 1.

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Correspondence to Thurid Ahlenstiel-Grunow.

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Ahlenstiel-Grunow, T., Pape, L. Diagnostics, treatment, and immune response in BK polyomavirus infection after pediatric kidney transplantation. Pediatr Nephrol 35, 375–382 (2020). https://doi.org/10.1007/s00467-018-4164-3

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