Urine cytology screening for polyoma virus infection following renal transplantation: the Oxford experience

• Published in: Journal of clinical pathology Vol. 60; no. 8; pp. 927 - 930
• Main Authors: Thamboo, Thomas P, Jeffery, Katie J M, Friend, Peter J, Turner, Gareth D H, Roberts, Ian S D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Association of Clinical Pathologists 01.08.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Anti-Infective Agents - therapeutic use; Biological and medical sciences; BK virus; Ciprofloxacin - therapeutic use; Humans; Immunosuppression - methods; Investigative techniques, diagnostic techniques (general aspects); Kidney Diseases - diagnosis; Kidney Diseases - urine; Kidney Transplantation; Medical sciences; Original; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Polymerase Chain Reaction - methods; polyoma virus nephropathy; Polyomavirus; Polyomavirus - isolation & purification; Polyomavirus Infections - diagnosis; Polyomavirus Infections - drug therapy; Polyomavirus Infections - urine; Postoperative Complications; PVN; Tumor Virus Infections - diagnosis; Tumor Virus Infections - drug therapy; Tumor Virus Infections - urine; Infection; Urine; Anatomic pathology; Treatment; Urinary system; Viral disease; Cytology; Transplantation; Medical screening; Kidney
• ISSN: 0021-9746; 1472-4146
• DOI: 10.1136/jcp.2006.042507

Objective: To review the first year of a monthly urine cytology screening service, introduced to identify renal transplant patients at risk of polyoma virus nephropathy (PVN), at an early, potentially treatable, stage. Methods and results: Monthly urine samples (n = 392) were received from 97/108 transplant recipients in 2005. Of 56 patients with follow-up >6 months, 20% and 9% had significant (>10 decoy cells/cytospin) and non-significant positive cytology, respectively. The first positive urine samples occurred most commonly in the second and third month post-transplantation and patients with significantly positive samples had higher 3-month and 6-month serum creatinine levels than patients with negative urine cytology (p<0.01). Four patients with positive urine cytology had a subsequent positive plasma BK virus PCR; 3/97 patients had biopsy-proven PVN, all in the third month, 1–6 weeks after first positive urine samples. Conclusions: Significant PV viruria is common following renal transplantation with onset usually within the first 3 months. Viruria is associated with worse graft function at 3 and 6 months. The time between urine positivity and clinical PVN is short. More frequent early urine screening would be required to achieve clinical benefit.