{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:26:07Z","timestamp":1787610367798,"version":"build-2736575974"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T00:00:00Z","timestamp":1728604800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T00:00:00Z","timestamp":1728604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Peter Stiftung"},{"DOI":"10.13039\/501100005941","name":"Dietmar Hopp Stiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005941","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018936","name":"Universit\u00e4tsklinikum Heidelberg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018936","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Nephrol"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>In kidney transplant recipients (KTR), BK polyomavirus-associated nephropathy (BKPyVAN) is a major cause of graft loss. To facilitate the clearance of BKPyV-DNAemia, reduction of immunosuppression is currently the treatment of choice but may increase the risk of graft rejection.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This international CERTAIN study was designed to determine the risk of alloimmune response and graft dysfunction associated with immunosuppression reduction for BKPyV treatment in 195 pediatric KTR.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>BKPyV-DNAemia was associated with a more than twofold increased risk of late T cell-mediated rejection (TCMR) (HR 2.22, <jats:italic>p<\/jats:italic>\u2009=\u20090.024), of de novo donor-specific HLA antibodies (dnDSA) and\/or antibody-mediated rejection (ABMR) (HR 2.64, <jats:italic>p<\/jats:italic>\u2009=\u20090.002), and of graft function deterioration (HR 2.73, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Additional independent risk factors for dnDSA\/ABMR development were a higher HLA mismatch (HR 2.72, <jats:italic>p<\/jats:italic>\u2009=\u20090.006) and re-transplantation (HR 6.40, <jats:italic>p<\/jats:italic>\u2009=\u20090.000). Other independent predictors of graft function deterioration were TCMR (HR 3.98, <jats:italic>p<\/jats:italic>\u2009=\u20090.003), higher donor age (HR 1.03, <jats:italic>p<\/jats:italic>\u2009=\u20090.020), and re-transplantation (HR 3.56, <jats:italic>p<\/jats:italic>\u2009=\u20090.013).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>These data indicate that reduction of immunosuppression for BKPyV-DNAemia management is associated with increased alloimmune response in pediatric KTR. Therefore, regular dnDSA screening and close monitoring of graft function in case of BKPyV-DNAemia followed by subsequent reduction of immunosuppressive therapy are recommended.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical sbstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00467-024-06501-7","type":"journal-article","created":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T09:01:59Z","timestamp":1728637319000},"page":"835-848","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk of cellular or antibody-mediated rejection in pediatric kidney transplant recipients with BK polyomavirus replication\u2014an international CERTAIN registry study"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9939-4059","authenticated-orcid":false,"given":"Alexander","family":"Fichtner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3816-7194","authenticated-orcid":false,"given":"Jeremy","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2521-8201","authenticated-orcid":false,"given":"Caner","family":"S\u00fcsal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9564-9491","authenticated-orcid":false,"given":"Andrea","family":"Carraro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3661-6176","authenticated-orcid":false,"given":"Matthias","family":"Zirngibl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"K\u00f6nig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4960-3083","authenticated-orcid":false,"given":"Isabella","family":"Guzzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4116-598X","authenticated-orcid":false,"given":"Lutz T.","family":"Weber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1615-2602","authenticated-orcid":false,"given":"Atif","family":"Awan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0409-5196","authenticated-orcid":false,"given":"Kai","family":"Krupka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Schnitzler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0883-0423","authenticated-orcid":false,"given":"Hans H.","family":"Hirsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6598-6910","authenticated-orcid":false,"given":"Burkhard","family":"T\u00f6nshoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4131-2273","authenticated-orcid":false,"given":"Britta","family":"H\u00f6cker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,11]]},"reference":[{"key":"6501_CR1","doi-asserted-by":"publisher","first-page":"e13528","DOI":"10.1111\/ctr.13528","volume":"33","author":"HH Hirsch","year":"2019","unstructured":"Hirsch HH, Randhawa PS, AST Infectious Diseases Community of Practice (2019) BK polyomavirus in solid organ transplantation-guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. 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Alexander Fichtner received travel grants from Astellas and Novartis. Lutz T. Weber received a research grant from Chiesi. Hans H. Hirsch reported grants from Moderna, consulting fees of AlCuris, Allovir, Moderna, VeraTx, and Roche, and speaker honoraria by VeraTx, Takeda, Biotest, and Gilead. Burkhard T\u00f6nshoff received research grants from Novartis, Astellas, and Chiesi, and consulting fees from Bristol-Myers Squibb, CSL Behring Biotherapies for Life, Vifor, and Chiesi. Britta H\u00f6cker received consulting fees from GlaxoSmithKline. Jeremy Schmidt, Caner S\u00fcsal, Andrea Carraro, Jun Oh, Matthias Zirngibl, Sabine K\u00f6nig, Isabella Guzzo, Atif Awan, Kai Krupka, and Paul Schnitzler have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}