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Background <p>BK polyomavirus (BKPyV)-associated nephropathy in kidney transplant recipients is an important cause of allograft dysfunction and premature allograft failure. Treatment options for BKPyV-DNAemia following kidney transplantation remain limited. Adjunctive pathogen adsorption devices such as the Seraph® 100 Microbind® Affinity Blood Filter (Seraph® 100) have previously been used for clearance of viruses, bacteria, and toxins in critical illness under FDA Emergency Use Authorization.</p> Case outline <p>An 18-year-old recipient of a deceased donor kidney transplant developed severe BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy refractory to reduced immunosuppression, antiviral therapy, and adjunctive intravenous immunoglobulin (IVIG). Given progressive allograft dysfunction, consideration was given to adjunctive extracorporeal therapies targeting BKPyV-DNAemia removal.</p> Complications <p>Despite multiple interventions including reduction of immunosuppression, cidofovir, leflunomide, and IVIG, BKPyV-DNAemia continued to worsen with levels reaching approximately 2 million copies/mL by 7&#xa0;months post-transplant. The patient developed de novo donor-specific antibodies and biopsy-proven antibody-mediated rejection concurrent with BKPyV-nephropathy and rising serum creatinine. Within 8&#xa0;weeks of Seraph® treatment, BKPyV-DNA levels resolved to &lt; 5000 copies/mL. During the subsequent 12-month follow-up period, her graft function stabilized with serum creatinine of 1.2–1.3&#xa0;mg/dL without proteinuria and stable class II DSA.</p> List of relevant guidelines <p>The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation (TTS 2024) [<CitationRef CitationID="CR1">1</CitationRef>]</p> <p>BK polyomavirus in solid organ transplantation – Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice (AST-IDCOP 2019) [<CitationRef CitationID="CR2">2</CitationRef>]</p>

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First-time use of pathogen absorptive device in severe BK DNAemia/BK polyomavirus-associated nephropathy post kidney transplantation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月24日

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  • Kyle A. Merrill,
  • Ruthellen H. Anderson,
  • David A. Axelrod,
  • Brynna Van Wyk,
  • Lyndsay A. Harshman

摘要

Background

BK polyomavirus (BKPyV)-associated nephropathy in kidney transplant recipients is an important cause of allograft dysfunction and premature allograft failure. Treatment options for BKPyV-DNAemia following kidney transplantation remain limited. Adjunctive pathogen adsorption devices such as the Seraph® 100 Microbind® Affinity Blood Filter (Seraph® 100) have previously been used for clearance of viruses, bacteria, and toxins in critical illness under FDA Emergency Use Authorization.

Case outline

An 18-year-old recipient of a deceased donor kidney transplant developed severe BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy refractory to reduced immunosuppression, antiviral therapy, and adjunctive intravenous immunoglobulin (IVIG). Given progressive allograft dysfunction, consideration was given to adjunctive extracorporeal therapies targeting BKPyV-DNAemia removal.

Complications

Despite multiple interventions including reduction of immunosuppression, cidofovir, leflunomide, and IVIG, BKPyV-DNAemia continued to worsen with levels reaching approximately 2 million copies/mL by 7 months post-transplant. The patient developed de novo donor-specific antibodies and biopsy-proven antibody-mediated rejection concurrent with BKPyV-nephropathy and rising serum creatinine. Within 8 weeks of Seraph® treatment, BKPyV-DNA levels resolved to < 5000 copies/mL. During the subsequent 12-month follow-up period, her graft function stabilized with serum creatinine of 1.2–1.3 mg/dL without proteinuria and stable class II DSA.

List of relevant guidelines

The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation (TTS 2024) [1]

BK polyomavirus in solid organ transplantation – Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice (AST-IDCOP 2019) [2]