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

Overview

Journal Viruses

Publisher MDPI

Specialty Microbiology

Date 2022 May 28

PMID 35632747

Authors

Ulrich Jehn

Sami Siam

Vanessa Wiening

Hermann Pavenstadt

Stefan Reuter

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Special Issue "New Frontiers in Small DNA Virus Research".

Strati K, Pyeon D Viruses. 2023; 15(1).

PMID: 36680299 PMC: 9865906. DOI: 10.3390/v15010259.

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