Managing Concurrent Antibody-Mediated Rejection and BK Polyomavirus Nephropathy After Kidney Transplantation: Successful Treatment Using CD38 Blockade.

Authors

Shuyang Traub, Thomas Menter, Stefan Schaub, Matthias Diebold

Published in

Kidney360. Oct 02, 2026. Epub Oct 02, 2026.

Abstract

The coexistence of antibody-mediated rejection (AMR) and BK polyomavirus-associated nephropathy (BKPyVAN) represents a major therapeutic challenge after kidney transplantation. Whereas treatment of AMR typically requires intensification of immunosuppression, management of BKPyVAN relies on reduction of immunosuppressive therapy to restore antiviral immune control. We report a kidney transplant recipient who developed active AMR with de novo donor-specific antibodies and concurrent BKPyVAN 12 weeks after transplantation. Given ongoing BKPyV replication, recent infectious complications, and concerns regarding further escalation of conventional immunosuppressive therapy, the patient was treated with pulse methylprednisolone followed by anti-CD38 therapy using daratumumab. Treatment resulted in recovery of allograft function, disappearance of donor-specific antibodies, and complete histological resolution of AMR. BKPyV replication subsequently declined and ultimately resolved without recurrent rejection. This case highlights CD38 blockade as a potential therapeutic option in selected patients with concomitant AMR and BKPyVAN. However, given the concurrent administration of corticosteroids and optimization of maintenance immunosuppression, these findings should be regarded as hypothesis-generating.

PMID:
42826058
Bibliographic data and abstract were imported from PubMed on 03 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.