Renal transplantation is the ultimate surgical treatment to save the life of a patient with irreversible renal failure. As we do blood grouping and cross matching before blood transfusion likewise we have to do tissue typing and cross matching to check the histocompatibility between the kidney donor and kidney recipient (the patient). Like the blood group antigens the other genetic system is 'human leukocyte antigens' (HLA) system controlling the histocompatibility. The success of the organ transplantation is related mainly to these two genetic systems as the immune response of an individual is controlled by the genes linked to the major histocompatibility complex (MHC). Renal transplantation is generally carried out after testing the histocompatibility even then there are chances of rejection of transplanted kidney as the immune system of the recipient recognizes it as foreign material. To avoid the transplant rejection the allograft recipient is put on immunosuppressive therapy. The survival and adaptation of transplanted kidney could only be achieved through non-nephrotoxic immunosuppression. The adverse effect of immunosuppression is that it promotes viral infections. BK virus nephritis (BKN) in recipients of renal allograft has been on the rise. Despite increased incidence, therapeutic options remain limited and progression of disease often leads to allograft failure (transplanted kidney failure). BK virus (BKV) replication in kidney transplant recipients may progress from asymptomatic viruria (viruses in urine) to progressive allograft dysfunction leading to allograft failure. BK virus infection may also lead to systemic infection and bladder cancer. The diagnosis of BKN could be achieved on the histology examination of the allograft biopsy by specific immunohistochemical (IHC) staining for BKV. The clinical and functional parameters often correlate with the duration and histological progression (stage) of nephropathy. Over or intense immunosuppression leads to complications. In the absence of specificantiviral therapy, the treatment of choice is to reduce the dose of maintenance immunosuppressive therapy. Non-nephrotoxic immunosuppressive drugs are the need of the hour for effective immunosuppression and renal allograft survival.
Tags: allograft failure, allograft recipient, antiviral therapy, histocompatibility, immunosuppressive therapy, kidney donor, kidney recipient, non-nephrotoxic immunosuppression, transplant rejection
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