Abstract
BackgroundBK virus is a polyoma virus causing renal allograft nephropathy. Reduction of immunosuppression with the early recognition of significant BK viral loads in urine and plasma can effectively prevent BKV associated nephropathy (BKVN), however the optimal compartment and frequency of BK viral load measurement post renal transplantation are undetermined. Our purpose was to examine time to detection and viral loads in urine compared to plasma, and establish viral load cut-offs associated with histological BKVN.MethodsWe performed a retrospective analysis of the BKV screening frequency and compartment(s) of 277 adult renal transplant recipients (RTR).ResultsBKVN was histologically diagnosed in 17 (6.1 %) RTR. In cases where both urine and plasma were tested fortnightly for 6 months (n = 53), BKV was detected in the urine 29 days earlier than plasma. Fortnightly (n = 72) versus 3-monthly (n = 78) testing demonstrated that BKV was detected in the urine significantly earlier (median 63 versus 97 days, p = 0.001) and at a lower level (median 3.27 versus 6.71 log10 c/mL, p < 0.001) with more frequent testing, but this difference was not evident in plasma first detection (80 versus 95 days, p = 0.536) or first positive viral load (3.18 versus 3.30 log10 c/mL, p = 0.603). The optimum cut-off BK viral load for histological diagnosis of BKVN was 4.10 log10 c/mL for the first positive urine, 3.79 log10 c/mL for the first positive plasma, 9.24 log10 c/mL for the peak urine, and 4.53 log10 c/mL for the peak plasma.ConclusionsFrequent urinary BK viral load screening for the prevention of BKVN is suggested due to its high sensitivity and earlier detection.
Highlights
BK virus is a polyoma virus causing renal allograft nephropathy
The median time to a histological diagnosis of BKV associated nephropathy (BKVN) was 233 days: in 4 patients virologically screened fortnightly this was 55, 67, 136, 283 days compared with eight patients screened every 3 months at 89, 99, 103, 170, 194, 233, 271, 324 days (p = 0.368)
There were no episodes of biopsyproven acute rejection (BPAR) following the diagnosis of BK nephropathy
Summary
BK virus is a polyoma virus causing renal allograft nephropathy. Reduction of immunosuppression with the early recognition of significant BK viral loads in urine and plasma can effectively prevent BKV associated nephropathy (BKVN), the optimal compartment and frequency of BK viral load measurement post renal transplantation are undetermined. BK virus (BKV) is a ubiquitous polyoma virus that causes a clinically important pattern of renal allograft injury in approximately 5 % of renal transplant recipients (RTR). Viral replication can occur in up to 60 % of recipients [1], in its most severe form, invasive disease leads to tubulointerstitial nephritis and allograft dysfunction with a significant risk of allograft failure in. Strategies involving early screening and pre-emptive management (mainly reduction in immunosuppression) can prevent long term graft dysfunction due to invasive disease [2]. Measures for the early identification of risk in order to prevent progression of viral replication and progressive infection are preferred
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