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Functional immune monitoring of BK Virus and donor‐specific T‐cell effector immune responses to guide treatment decision‐making after kidney transplantation; an illustrative case report and literature review

Differential diagnosis between Polyoma virus associated‐nephropathy (PVAN) and T‐cell mediated rejection (TCMR) might be challenging, as respective treatment approaches are totally opposite. Here we report the illustrative case of a kidney transplant recipient with PVAN who developed a persistent acute TCMR after full abrogation of viral infection through immunosuppression modulation. By simultaneous functional immune monitoring of BKV and donor‐specific T‐cell responses using IFN‐γELISPOT assay, we retrospectively demonstrated the predominant effector mechanisms responsible of allograft injury and thus, potential guidance for treatment decision‐making. Furthermore, the evidence of an efficient T‐cell alloimmunity abrogation accompanied by a sustained anti‐viral response after sirolimus addition, promotes the potential benefit of converting patients to an mTOR‐based immunosuppression in case of PVAN.