Guidelines for BK Polyomavirus (BKPyV) Infection of Solid Organ Transplants (2019)

American Society of Transplantation (AST) Infectious Diseases Community of Practice

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

March 27, 2019

Guidelines on screening and treatment of BK polyomavirus (BKPyV) infection of solid organ transplants were released in March 2019 by the American Society of Transplantation (AST) Infectious Diseases Community of Practice.[1]

All kidney transplant recipients should undergo monthly screening for BK polyomavirus (BKPyV) DNAemia for the first nine months following transplantation and then every three months until 2 years posttransplant.

BKPyV-DNAemia screening beyond 2 years posttransplant may be considered in pediatric kidney transplant recipients.

Plasma BKPyV-DNAemia exceeding 1000 copies/mL sustained for 3 weeks or a finding of more than 10,000 copies/mL suggests probable and presumptive BKPyV-associated nephropathy, indicating stepwise immunosuppression reduction.

Biopsy-confirmed BKPyV-associated nephropathy is also treated primarily with immunosuppression reduction, so biopsy of the allograft is unnecessary in the treatment of BKPyV-DNAemia in patients with baseline renal function.

Treatment recommendations such as switching from tacrolimus to cyclosporine-A, switching from mycophenolate to mTOR inhibitors or leflunomide, or using IV immunoglobulins, leflunomide, or cidofovir adjunctively cannot be made because of a lack of randomized clinical trials.

Fluoroquinolone antibiotics are not recommended for BKPyV prophylaxis or treatment.

If BKPyV-DNAemia is definitively cleared after allograft loss caused by BKPyV nephropathy, retransplantation can be successful.

For more information, please go to Infections After Solid Organ Transplantation.

For more Clinical Practice Guidelines, please go to Guidelines.

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