Early Diagnosis of Polyomavirus Type BK Infection in Tailoring Immunosuppression for Kidney Transplant Patients: Screening With Urine Qualitative Polymerase Chain Reaction Assay

• Published in: Transplantation proceedings Vol. 40; no. 7; pp. 2389 - 2391
• Main Authors: Wu, S.W, Chang, H.R, Hsieh, M.C, Chiou, H.L, Lin, C.C, Lian, J.D
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2008; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Biopsy; BK Virus - genetics; BK Virus - isolation & purification; Creatinine - blood; DNA Primers; DNA, Viral - genetics; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunosuppressive Agents - therapeutic use; Infectious diseases; Kidney Transplantation - immunology; Kidney Transplantation - pathology; Male; Medical sciences; Middle Aged; Polymerase Chain Reaction; Polyomavirus Infections - diagnosis; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Urine - virology; Viral diseases; Customization; Early stage; Transplantation; Papovaviridae; Homotransplantation; Kidney; Assay; Surgery; Graft; Diagnosis; Human; Urine; Opportunistic infection; Polyomavirus; Patient; Medical screening; Infection; Virus; Medicine; Polymerase chain reaction; Immunosuppression; Type; Treatment; Urinary system; Viral disease; Molecular biology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.06.025

Abstract Polyomavirus type BK (BKV) nephropathy is increasingly a significant cause of graft dysfunction and even failure. Early diagnosis followed by reduction of immunosuppression has been associated with an improved prognosis. We screened 250 patients with the urine qualitative polymerase chain reaction (PCR) for BKV DNA. We followed with blood BKV PCR if the urine screen was positive and then reduced immunosuppression in viremic patients. One hundred ninety-nine patients (80%) had no viuria; 43 (17%) viuria; and 8 (3%) both viuria and viremia. Graft biopsy performed in three patients (1%) with viremia and impaired graft function all revealed BKV nephropathy. After 6 months of follow-up, seven out of eight viremic patients (88%) had negative repeat blood PCR and stabilized graft function. An early diagnosis of BKV infection with reduction of immunosuppression may reverse viremia and retard progression of BKV nephropathy. BKV screening by PCR assays should be considered in kidney transplant recipients, especially those with impaired graft function.