TABLE 11.

Consensus recommendations: retransplantation

• We recommend retransplantation in otherwise eligible patients who lost their prior allograft from BKPyV-nephropathy (strong, B)

• We suggest that BKPyV-DNAemia be resolved before retransplantation (weak, C)

• We suggest not routinely performing graft nephrectomy before retransplantation in those patients with allograft failure subsequent to BKPyV-nephropathy having undetectable BKPyV-DNAemia (weak, C)

• There is insufficient information to make recommendations on the choice of immunosuppression for a subsequent kidney transplant after a prior kidney transplant failed because of BKPyV-nephropathy (no recommendation—statement only)

Future directions

➢ Evaluate the need for BKPyV-DNAemia clearance before retransplantation in patients with a failed kidney transplant from BKPyV-nephropathy

➢ Evaluate thresholds of BKPyV-specific immunity, such as neutralizing antibody titers and CMI, predicting increased risk or protection from recurrent BKPyV-DNAemia/-nephropathy

➢ Evaluate the need for significant BKPyV-DNAuria decrease or clearance before retransplantation in patients with a failed kidney transplant from BKPyV-nephropathy

➢ Evaluate the need for nephrectomy in patients with a failed transplant from BKPyV-nephropathy and persistent BKPyV-DNAemia before retransplantation

➢ Evaluate the role of nephrectomy before retransplantation in patients with a previous multiorgan transplant and a failed kidney transplant from BKPyV-nephropathy

BKPyV, BK polyomavirus; CMI, cell-mediated immunity.