Abstract
The human polyomavirus BK (BKV) is linked to two ma-jor complications in transplant recipients, polyomavirus-associated nephropathy (PyVAN) (1–4) and polyomavirus-associated hemorrhagic cystitis (PyVHC) (5,6). PyVAN andPyVHC have been encountered in a variety of immunod-eficient patients (7,8), but most cases of PyVAN arise inkidney transplant patients at rates of 1–10%, while PyVHCpreferentially affects allogeneic hematopoietic stem celltransplant patients at rates of 5–15% (7,9). BKV hasbeen less frequently associated with other pathologies,such as ureteric stenosis, pneumonitis, hemophagocyticsyndrome, encephalitis, retinitis, multiorgan failure andpolyomavirus-associated multifocal leukoencephalopathy(PyVML) (10–12), a complication of the central nervoussystem mostly caused by the closely related polyomavirusJC (JCV) (13). The objective of this section is to updateprevious recommendations (14) regarding diagnosis andmanagement of BKV replication and PyVAN in solid organtransplantation (SOT) using the grading proposed by Grosset al. (15).BKV belongs to the family Polyomaviridaetogether withfive other polyomaviruses detected in human specimens,that is JCV, KI virus, WU virus, Merkel cell carcinoma virusand Simian virus 40 (16,17). The virions are nonenvelopedparticles of 42 nm diameter and fairly resistant to envi-ronmental inactivation (18). The circular double-strandedDNA genome of
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