Extracorporeal photopheresis in BK virus infection after kidney transplantation: current evidence and emerging clinical applications
Abstract
BK polyomavirus (BKPyV) infection is a major complication after kidney transplantation, with no approved antiviral therapy and management reliant on immunosuppression reduction, which increases rejection risk. This review outlines the biological rationale for extracorporeal photopheresis (ECP) in infectious settings and critically appraises the current evidence for its use in BKPyV replication and BKPyV-associated nephropathy (BKPyVAN). ECP is an immunomodulatory therapy that induces apoptosis of apheresis-isolated mononuclear cells via ex vivo exposure to a photoactivatable agent and UVA light; reinfusion promotes tolerogenic dendritic cells, regulatory T-cell expansion, and cytokine modulation. Its antiviral potential was first observed in cytomegalovirus, with ECP linked to reduced viral burden in heart, lung, and hematopoietic transplantation. Experience in BKPyV is more limited, restricted to small case series and reports, where ECP combined with immunosuppression reduction was associated with sustained reductions in viremia, reaching >99% in individual series, without increased rejection. These uncontrolled, confounded designs cannot isolate an ECP-specific antiviral effect, and the proposed antiviral mechanism remains hypothetical. ECP may be a promising adjunctive strategy in selected high-risk patients with persistent BKPyV viremia or BKPyVAN, but prospective, controlled studies are needed to confirm efficacy and define optimal use.
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BibTeX
@article{gonzalez2026extracorporeal,
title = {{Extracorporeal photopheresis in BK virus infection after kidney transplantation: current evidence and emerging clinical applications}},
author = {Ángela González and Marc Xipell and Víctor J Escudero-Saiz and Carolt Arana and Michael Nicoli and Jordi Rovira and Paola Charry and Marta Bodro and Pedro Ventura-Aguiar and Miquel Lozano and Fritz Diekmann},
journal = {Clinical kidney journal},
year = {2026},
month = oct,
doi = {10.1093/ckj/sfag251},
url = {https://europepmc.org/article/PMC/PMC13728341},
note = {CC BY},
}
RIS
TY - JOUR
TI - Extracorporeal photopheresis in BK virus infection after kidney transplantation: current evidence and emerging clinical applications
AU - Ángela González
AU - Marc Xipell
AU - Víctor J Escudero-Saiz
AU - Carolt Arana
AU - Michael Nicoli
AU - Jordi Rovira
AU - Paola Charry
AU - Marta Bodro
AU - Pedro Ventura-Aguiar
AU - Miquel Lozano
AU - Fritz Diekmann
PY - 2026
DA - 2026/10/29
JO - Clinical kidney journal
DO - 10.1093/ckj/sfag251
UR - https://europepmc.org/article/PMC/PMC13728341
AB - BK polyomavirus (BKPyV) infection is a major complication after kidney transplantation, with no approved antiviral therapy and management reliant on immunosuppression reduction, which increases rejection risk. This review outlines the biological rationale for extracorporeal photopheresis (ECP) in infectious settings and critically appraises the current evidence for its use in BKPyV replication and BKPyV-associated nephropathy (BKPyVAN). ECP is an immunomodulatory therapy that induces apoptosis of apheresis-isolated mononuclear cells via ex vivo exposure to a photoactivatable agent and UVA light; reinfusion promotes tolerogenic dendritic cells, regulatory T-cell expansion, and cytokine modulation. Its antiviral potential was first observed in cytomegalovirus, with ECP linked to reduced viral burden in heart, lung, and hematopoietic transplantation. Experience in BKPyV is more limited, restricted to small case series and reports, where ECP combined with immunosuppression reduction was associated with sustained reductions in viremia, reaching >99% in individual series, without increased rejection. These uncontrolled, confounded designs cannot isolate an ECP-specific antiviral effect, and the proposed antiviral mechanism remains hypothetical. ECP may be a promising adjunctive strategy in selected high-risk patients with persistent BKPyV viremia or BKPyVAN, but prospective, controlled studies are needed to confirm efficacy and define optimal use.
SN - 2048-8505
SN - 2048-8513
ER -