BK Virus Screening and Management: A Provider Survey.

Abstract

Introduction: Routine BK virus (BKV) screening is recommended for all renal transplant recipients and reduces rates of allograft dysfunction and loss due to BKV nephropathy. The optimal approach to BKV surveillance remains controversial. We hypothesize that BKV screening and management practices vary significantly across transplant centers. Methods: Using the United Network for Organ Sharing (UNOS) website, all US transplant centers that performed 50 or more renal transplants in 2011 were identified (N = 110). We sent a 10-question, multiple-choice, web-based survey on BKV screening and management practices to a transplant surgeon, nephrologist, and infectious disease (ID) physician at each institution. Results: We received survey responses from 48 providers from 43/110 (39%) centers. 47.9% of respondents were nephrologists, 31.3% surgeons, and 20.8% ID physicians. Reported method of BKV screening was blood PCR only (41.7%), urine and blood PCR (37.5%), urine PCR only (16.7%), urine cytology (2.1%), and no screening (2.1%). Reported timing of BKV screening during the first year post-transplant was monthly for the first 3 months, then at months 6 and 12 (33.3%), monthly for 6 months, then at months 9 and 12 (25.0%), monthly (25.0%), and every 3 months (16.7%). 100% of respondents reduce immunosuppression in response to BKV reactivation. In addition, some respondents reported utilization of leflunomide (45.8%), cidofovir (20.8%), a quinolone (14.6%), and IVIG (8.3%). The criteria for intervention varied between institutions, with the most commonly reported indications being any BK viremia (52.1%) and BK viremia > 10,000 copies/mL (39.6%). Interestingly, among the 5 centers for which there was more than one respondent, different screening and management practices were reported by respondents from the same center. Conclusions: BKV screening and management practices vary greatly between and perhaps within transplant centers. Unfortunately, this survey did not capture the impact of these differing practices on patient outcomes. Additional data on the efficacy of various BKV screening protocols and interventions could lead to the development of a standardized, simplified, and more cost-effective approach to BKV management among renal transplant recipients.