Native BK Viral Nephropathy After Pediatric Heart Transplantation Treated With Bilateral Native Nephrectomy and Living Donor Kidney Transplantation: A Case Report.

Background: BK Polyoma virus (BKV) can lead to significant renal complications in immunocompromised individuals. While commonly observed in kidney transplant recipients, its occurrence in non-renal solid organ transplant (NRSOT) recipients remains rare. The mainstay of treatment for BKV nephropathy in these patients involves careful reduction of immunosuppression.

Summary: In this report, we present a unique case of end-stage renal disease due to refractory BKV nephropathy in a pediatric heart transplant patient. The patient was treated with bilateral native nephrectomy to eliminate the viral reservoir with clearance of her BK viremia. This led to a six-month period of viral clearance, allowing for subsequent living donor kidney transplantation (LDKT).

Conclusion: BKV nephropathy is a rare entity in NRSOT patients. This case highlights the successful management of refractory BKV nephropathy in a pediatric heart transplant recipient through bilateral native nephrectomy, leading to an extended period of viral clearance and subsequent LDKT. Further studies are needed to explore the broader applicability of this approach in NRSOT recipients.