Grand Rounds in Pediatric Nephrology – an ISN-IPNA Sister Centers initiative: Immunosuppression vs post-transplant viral infections: Walking a fine line
BK virus (BKV) is a common infection after kidney transplant (KT), with rising prevalence in the era of more potent immunosuppression. Uncontrolled, BKV infection can lead to BK-associated nephropathy, irreversible damage, and graft loss. Concurrent BKV nephropathy and acute rejection is not uncommon, and treatment is challenging. We discuss the case of a child who presented three years after living donor KT with fever, weight loss, GI symptoms, and acute graft dysfunction. Virology screen revealed CMV, BKV, and EBV viremia. Kidney biopsy showed acute cellular rejection. Optimized immunosuppression and antiviral therapy resulted in resolution of viremia and nearly baseline creatinine.
- Describe common latent viral infections after transplant
- Outline challenges of balancing immunosuppressive medications in the presence of viral infection post-transplant
- Discuss treatment strategies and prevention of latent viral infections post-transplant