Effects of intravenous immunoglobulin (IVIG) treatment on BK viremia and BK virus-associated nephropathy (BKVN) in kidney transplant patients: A systematic review

Abstract

Background: There are limited approved therapeutic options for BK viremia management in kidney transplant patients. We performed the present study to investigate the effect of Intravenous immunoglobulin (IVIG) treatment on BK viremia and BK virus-associated nephropathy (BKVN) in kidney transplant patients. Methods: A systematic search was performed in Web of Science, Embase, PubMed, and Scopus for studies that investigated the effect of IVIG therapy on BK viremia and BKVN in kidney transplant patients. Observational studies and case series were considered eligible for inclusion in this study. Data extraction was performed by two independent investigators by a standard checklist. Findings: Our results indicated that IVIG treatment in patients with BKVN was effective in BK viremia treatment and nephropathy. In addition, preemptive IVIG significantly decreased the risk of BK viremia and BKVN in highrisk patients. However, it does not seem that IVIG treatment has a beneficial impact on allograft function. Because no significant improvement in serum levels of creatinine has been reported in previous studies. In addition, the presence of interstitial fibrosis or tubular atrophy was reported in studies with histopathological examinations of renal biopsies following IVIG treatment. Conclusion: IVIG therapy combined with immunosuppression reduction may be beneficial in treating BK viremia and BKVN, but its impact on graft function and survival remains uncertain. Further studies are needed to clarify its role in kidney transplant outcomes.