TABLE 8.
Consensus recommendations: pediatric kidney transplantation
| • For pediatric kidney transplant recipients, we recommend monthly screening for plasma BKPyV-DNAemia until mo 9, then every 3 mo until mo 24 posttransplant (strong, B), and we suggest further screening every 3 mo until mo 36 posttransplant (weak, C) |
| • We recommend reducing maintenance immunosuppression as the primary intervention of sustained BKPyV-DNAemia, presumptive, or biopsy-proven BKPyV-nephropathy in pediatric kidney transplant patients without concurrent acute rejection (strong, B) |
| • For pediatric kidney transplant recipients with BKPyV-DNAemia, we recommend performing a kidney biopsy as clinically indicated (eg, rise in serum creatinine, new-onset proteinuria, hematuria; strong, A) |
| • For pediatric patients with stable kidney transplant function and persistent BKPyV-DNAemia >10 000 c/mL (or equivalent) despite reducing immunosuppression, we suggest performing a renal allograft biopsy because serum creatinine rise may be delayed in children with significant renal injury including rejection (weak, B) |
| • For pediatric kidney transplant patients, we suggest to not use adjunctive therapies, including leflunomide, cidofovir, or fluoroquinolones, because of the lack of well-designed studies, poorly documented efficacy, and confounders arising from concomitant reduction in immunosuppression (weak, D) |
| Future directions |
| ➢ Evaluate the role of pretransplant BKPyV serology (qualitative and quantitative) in donor and pediatric recipient pairs to predict the risk of BKPyV-DNAemia/-nephropathy |
| ➢ Evaluate the role of pretransplant and posttransplant BKPyV-specific CMI (qualitative and quantitative) to predict BKPyV-DNAemia/-nephropathy and to guide reducing immunosuppression |
| ➢ Evaluate the role of antibody preparations in targeting and neutralizing BKPyV (sub-)types for preventing or treating BKPyV-DNAemia/-nephropathy |
| ➢ Evaluate the role of adoptive T-cell therapy for preventing or treating BKPyV-DNAemia/-nephropathy |
BKPyV, BK polyomavirus; CMI, cell-mediated immunity.