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BK Nephropathy Adjunctive IVIg — ESENeph MCQ

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HardTransplantationBK Nephropathy Adjunctive IVIgESENeph

A kidney transplant recipient on Tacrolimus develops polyomavirus-associated nephropathy (PVAN) confirmed on biopsy (SV40 staining positive). His Tacrolimus has been reduced and Mycophenolate stopped. BK viraemia persists at 50000 copies/mL. What experimental adjunctive therapy has been tried?

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Correct answer: B — IV immunoglobulin (IVIg) – has been used as adjunctive therapy to provide anti-BK virus antibodies

There is no approved antiviral for BK virus. After immunosuppression reduction (first-line), adjunctive therapies that have been tried include IVIg (passive transfer of anti-BK antibodies), Cidofovir (limited efficacy, nephrotoxic), Leflunomide (immunomodulatory), and fluoroquinolones (in vitro activity, no clinical evidence). IVIg has the most supporting evidence among adjunctive therapies, though it remains experimental. mTOR inhibitor-based regimens may provide both immunosuppression and antiviral properties.

Reference: Hirsch et al 2019 – BK Virus; KDIGO 2009 – Transplant