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Management of BK-virus infection - Swedish recommendations.

Journal article
Authors Tina Dalianis
Britt-Marie Eriksson
Marie Felldin
Vanda Friman
Anna-Lena Hammarin
Maria Herthelius
Per Ljungman
Johan Mölne
Lars Wennberg
Lisa Swartling
Published in Infectious diseases (London, England)
Volume 51
Issue 7
Pages 479-84
ISSN 2374-4243
Publication year 2019
Published at Institute of Biomedicine, Department of Pathology
Pages 479-84
Language en
Links dx.doi.org/10.1080/23744235.2019.15...
www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords BK-virus nephropathy, transplantation, antiviral therapy
Subject categories Infectious Medicine

Abstract

BK-virus (BKV) associated nephropathy (BKVAN) and BKV associated haemorrhagic cystitis (HC) are complications of BKV infection/reactivation in renal and allogeneic haematopoietic stem cell transplantation (HSCT) patients, respectively. The task of how to manage these diseases was given to the chair by the Swedish Reference Group for Antiviral Therapy (RAV). After individual contributions by members of the working group, consensus discussions were held in a meeting on 23 January 2018 arranged by RAV. Thereafter, the recommendations were published in Swedish on November 2018. The current translation to English has been approved by all co-authors. High BKV serum levels suggest an increased risk for BKVAN and potential graft failure. For detection of BKVAN, careful monitoring of BKV DNA levels in serum or plasma is recommended the first year after renal transplantation and when increased creatinine serum levels of unknown cause are observed. Notably, a renal biopsy is mandatory for diagnosis. To reduce the risk for progression of BKVAN, there is no specific treatment, and tailored individual decrease of immunosuppression is recommended. For BKV-HC, BKV monitoring is not recommended, since BK-viruria frequently occurs in HSCT patients and the predictive value of BKV in plasma/serum has not been determined. However, the risk for BKV-HC is higher for patients undergoing myeloablative conditioning, having an unrelated, HLA-mismatched, or a cord blood donor, and awareness of the increased risk and early intervention may benefit the patients. Also for BKV-HC, no specific therapy is available. Symptomatic treatment, e.g. forced diuresis and analgesics could be of use.

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