Kotton, Camille N.Kamar, NassimWojciechowski, DavidEder, MichaelHopfer, HelmutRandhawa, ParmjeetSester, MartinaComoli, PatriziaTedesco-Silva, HelioKnoll, GregBrennan, Daniel C.Trofe-Clark, JenniferPape, LarsAxelrod, David A.Kiberd, BryceWong, GermaineHirsch, Hans H.Transplantation Society International BK Polyomavirus Consensus Group2024-11-112024-11-112024Kotton CN, Kamar N, Wojciechowski D, Eder M, Hopfer H, Randhawa P, et al. The second international consensus guidelines on the management of BK Polyomavirus in kidney transplantation. Transplantation. 2024 Sep 1;108(9):1834-66. DOI: 10.1097/TP.00000000000049760041-1337http://hdl.handle.net/10230/68481BK polyomavirus (BKPyV) remains a significant challenge after kidney transplantation. International experts reviewed current evidence and updated recommendations according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Risk factors for BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy include recipient older age, male sex, donor BKPyV-viruria, BKPyV-seropositive donor/-seronegative recipient, tacrolimus, acute rejection, and higher steroid exposure. To facilitate early intervention with limited allograft damage, all kidney transplant recipients should be screened monthly for plasma BKPyV-DNAemia loads until month 9, then every 3 mo until 2 y posttransplant (3 y for children). In resource-limited settings, urine cytology screening at similar time points can exclude BKPyV-nephropathy, and testing for plasma BKPyV-DNAemia when decoy cells are detectable. For patients with BKPyV-DNAemia loads persisting >1000 copies/mL, or exceeding 10 000 copies/mL (or equivalent), or with biopsy-proven BKPyV-nephropathy, immunosuppression should be reduced according to predefined steps targeting antiproliferative drugs, calcineurin inhibitors, or both. In adults without graft dysfunction, kidney allograft biopsy is not required unless the immunological risk is high. For children with persisting BKPyV-DNAemia, allograft biopsy may be considered even without graft dysfunction. Allograft biopsies should be interpreted in the context of all clinical and laboratory findings, including plasma BKPyV-DNAemia. Immunohistochemistry is preferred for diagnosing biopsy-proven BKPyV-nephropathy. Routine screening using the proposed strategies is cost-effective, improves clinical outcomes and quality of life. Kidney retransplantation subsequent to BKPyV-nephropathy is feasible in otherwise eligible recipients if BKPyV-DNAemia is undetectable; routine graft nephrectomy is not recommended. Current studies do not support the usage of leflunomide, cidofovir, quinolones, or IVIGs. Patients considered for experimental treatments (antivirals, vaccines, neutralizing antibodies, and adoptive T cells) should be enrolled in clinical trials.application/pdfeng© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/Ronyons--TrasplantacióPoliomavirusinfo:eu-repo/semantics/articlehttp://dx.doi.org/10.1097/TP.0000000000004976info:eu-repo/semantics/openAccess