Belatacept as a Treatment Option in Patients with Severe BK Polyomavirus Infection and High Immunological Risk-Walking a Tightrope between Viral Control and Prevention of Rejection

Balancing the immune system with immunosuppressive treatment is essential in kidney transplant recipients to avoid allograft rejection on the one hand and infectious complications on the other. BK polyomavirus nephropathy (BKPyVAN) is a viral complication that seriously threatens kidney allograft su...

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Bibliographic Details
Published in:Viruses 2022-05, Vol.14 (5), p.1005
Main Authors: Jehn, Ulrich, Siam, Sami, Wiening, Vanessa, Pavenstädt, Hermann, Reuter, Stefan
Format: Article
Language:English
Subjects:
allograft rejection
belatacept
Biopsy
BK polyomavirus
BKPyV-associated nephropathy
Calcineurin
Case Report
CD28 antigen
CD80 antigen
Effector cells
Graft rejection
Immune response (humoral)
Immune system
Immunosuppression
Immunosuppressive agents
Infections
Kidney transplantation
Kidney transplants
Lymphocytes T
Nephropathy
Patients
Steroids
Transplants & implants
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Summary:Balancing the immune system with immunosuppressive treatment is essential in kidney transplant recipients to avoid allograft rejection on the one hand and infectious complications on the other. BK polyomavirus nephropathy (BKPyVAN) is a viral complication that seriously threatens kidney allograft survival. Therefore, the main treatment strategy is to reduce immunosuppression, but this is associated with an increased rejection risk. Belatacept is an immunosuppressant that acts by blocking the CD80/86-CD28 co-stimulatory pathway of effector T-cells with marked effects on the humoral response. However, when compared with calcineurin-inhibitors (CNI), the cellular rejection rate is higher. With this in mind, we hypothesized that belatacept could be used as rescue therapy in severely BKPyV-affected patients with high immunological risk. We present three cases of patients with BKPyVAN-associated complications and donor-specific antibodies (DSA) and one patient who developed T-cell-mediated rejection after a reduction in immunosuppression in response to BKPyVAN. Patients were switched to a belatacept-based immunosuppressive regimen and showed significantly improved viral control and stabilized graft function. The cases presented here suggest that belatacept is a potential treatment option in the complicated situation of refractory BKPyV infection in patients with high immunological risk.
ISSN:1999-4915
1999-4915
DOI:10.3390/v14051005