Febrile 130: Trolls of Transplant with NephMadness 2026!
Mar 2, 2026
Samira Farouk, transplant nephrologist and NephMadness organizer; Jeannina Smith, transplant infectious disease lead focused on CMV and BK; Caitlin Blaschart, nephrology fellow specializing in transplant kidney disease. They chat about the Trolls of Transplant region, BK biology and surveillance, CMV biology and prevention strategies, immunosuppression as core therapy, and emerging immune and antiviral approaches.
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Chapters
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Episode notes
CMV Offers Antiviral Targets
- CMV is a large herpesvirus with a polymerase and kinase that provide multiple antiviral targets.
- Hariharasudan Natarajan notes CMV hides in hematopoietic progenitors, causing systemic disease and allowing antivirals to be effective.
Screen Regularly And Act On BK Viremia
- Screen kidney transplant recipients for BK DNA regularly early after transplant and act on high or persistent viremia.
- Caitlin Blaschart recommends monthly then q3monthly screening for ~2 years and lowering immunosuppression if viral load >10,000 copies/mL or persistent.
Tailor CMV Prevention To Immunity And Logistics
- Use antiviral prophylaxis or preemptive monitoring for CMV tailored to donor/recipient serostatus and center logistics.
- Janina Smith emphasizes balancing antiviral suppression with allowing some immune education to reduce post-prophylaxis surges.