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[...]rejection episodes occurring from week 6 are more likely to be pathophysiological and clinically comparable to those preceded by BKPyV DNAemia. Data were analyzed using Chi-square test, One-way ANOVA, and linear Mixed-Effects Model (LMM) to assess longitudinal eGFR trends at 6 weeks, 6 months, 1 year, 3 years and 5 years after transplantation. With regard to rejection treatment, patients in the BKPyV-BPAR group more often received less immunosuppressive treatment than recommended by the local rejection management protocol (details in Supplementary Table S1a), compared to those in the BPAR-only group (19.7% vs. 56.3%, p < 0.001). [...]the initiation of rejection treatment — measured from the time of a ≥20% rise in serum creatinine — was significantly delayed in the BKPyV-BPAR group compared to the BPAR-only group (average of 16.5 ± 23.1 vs. 7.8 ± 10.5 days, p = 0.012). [...]this study shows that patients in whom BPAR was preceded by BKPyV DNAemia experienced both delayed initiation and less intensive rejection treatment, compared to patients with BPAR without prior BKPyV DNAemia.

This report describes a man in his late 50s who underwent donation-after-circulatory-death kidney transplantation in 2012, due to end-stage kidney disease of unknown origin. More than a decade post-transplant, he presented with a progressive decline in graft function after maintenance immunosuppression had been reduced due to multiple skin carcinomas and the prolonged time since transplantation. Kidney biopsy revealed chronic-active tubulointerstitial nephritis with positive immunohistochemical staining for SV40, initially raising suspicion for BK polyomavirus-associated nephropathy. However, quantitative PCR (qPCR) analysis for BKPyV in both plasma and tissue was negative. In contrast, qPCR for JC polyomavirus (JCPyV) was positive in both plasma and biopsy tissue, leading to the diagnosis of JC polyomavirus nephropathy. Despite the reduction of immunosuppressive therapy, the patient experienced ongoing deterioration of graft function. Our report adds to the limited but growing body of literature on JCPyV and emphasises the need for increased clinical awareness and further research into its prevalence, pathogenesis and optimal management in kidney transplant recipients.