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Ganesh K, Abraham MA, Thomas R, Kumar J, Simon S. BK virus nephropathy in renal transplantation and the effect of intravenous immunoglobulin: A prospective longitudinal single-center study in South Asia. INDIAN JOURNAL OF TRANSPLANTATION 2023. [DOI: 10.4103/ijot.ijot_43_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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2
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Abeywardana KDST, Rajamanthri RGLS, Wazil AWM, Nanayakkara N, Muthugala MARV. Longitudinal viral kinetic study of BK virus in renal transplant patients-A single-centre study in Sri Lanka. JOURNAL OF CLINICAL VIROLOGY PLUS 2022. [DOI: 10.1016/j.jcvp.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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3
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The effect of BK polyomavirus large T antigen on CD4 and CD8 T cells in kidney transplant recipients. Transpl Immunol 2022; 74:101655. [PMID: 35777612 DOI: 10.1016/j.trim.2022.101655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/01/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022]
Abstract
Human BK polyomavirus (BKPyV) can affect the machinery of the host cell to induce optimal viral replication or transform them into tumor cells. Reactivation of BKPyV happens due to immunosuppression therapies following renal transplantation which might result in BK polyomavirus nephropathy (BKPyVAN) and allograft loss. The first protein that expresses after entering into host cells and has an important role in pathogenicity is the Large T antigen (LT-Ag). In this review tries to study the molecular and cellular inter-regulatory counteractions especially between CD4 and CD8 T cells, and BKPyV LT-Ag may have role in nephropathy after renal transplantation.
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4
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BK Polyomavirus Nephropathy in Kidney Transplantation: Balancing Rejection and Infection. Viruses 2021; 13:v13030487. [PMID: 33809472 PMCID: PMC7998398 DOI: 10.3390/v13030487] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/16/2022] Open
Abstract
BK polyomavirus nephropathy (BKVN) and allograft rejection are two closely-associated diseases on opposite ends of the immune scale in kidney transplant recipients. The principle of balancing the immune system remains the mainstay of therapeutic strategy. While patient outcomes can be improved through screening, risk factors identification, and rapid reduction of immunosuppressants, a lack of standard curative therapy is the primary concern during clinical practice. Additionally, difficulty in pathological differential diagnosis and clinicopathology’s dissociation pose problems for a definite diagnosis. This article discusses the delicate evaluation needed to optimize immunosuppression and reviews recent advances in molecular diagnosis and immunological therapy for BKVN patients. New biomarkers for BKVN diagnosis are under development. For example, measurement of virus-specific T cell level may play a role in steering immunosuppressants. The development of cellular therapy may provide prevention, even a cure, for BKVN, a complex post-transplant complication.
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5
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Hussain I, Tasneem F, Gilani US, Arshad MI, Farhan Ul Haque M, Abbas Z, Umer M, Shahzad N. Human BK and JC polyomaviruses: Molecular insights and prevalence in Asia. Virus Res 2020; 278:197860. [PMID: 31911182 DOI: 10.1016/j.virusres.2020.197860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
Polyomaviridae family consists of small circular dsDNA viruses. Out of the 14 human polyomaviruses described so far, BKPyV and JCPyV have been studied extensively since their discovery in 1971. Reportedly, both BKPyV and JCPyV are widely distributed across the globe with the frequency of 80-90 % in different populations. The primary infection of these viruses is usually asymptomatic and latent which is activated as a consequence of immunosuppression. Activated BKPyV and JCPyV viruses lead to the development of BK Virus Associated Nephropathy and Progressive Multifocal Leukoencephalopathy, respectively. Immense progress has been made during the last few decades regarding the molecular understanding of polyomaviruses. Epidemiology of polyomaviruses has also been studied extensively. However, most of the epidemiological studies have focused on European and American populations. Therefore, limited data is available regarding the geographical distribution of these potentially oncogenic viruses in Asian countries. In this article, we have presented a compendium of latest advances in the molecular understanding of polyomaviruses and their pathobiology. We also present a comprehensive review of published literature regarding the epidemiology and prevalence of BKPyV and JCPyV in Asian regions. For this purpose, a thorough search of available online resources was performed. As a result, we retrieved 24 studies for BKPyV and 22 studies for JCPyV, that describe their prevalence in Asia. These studies unanimously report high occurrence of both BKPyV and JCPyV in Asian populations. The available data from these studies was categorized into two groups: on the basis of prevalence (low, medium and high) and disease development (healthy and diseased). Altogether, Korean population hasbeen evidenced to possess highest frequency of BKPyV (66.7 %), while JCPyV was found to be most prevalent in Taiwan (88 %). Due to high and ubiquitous distribution of these viruses, frequent studies are required to develop a better understanding regarding the epidemiology and pathobiology of these viruses in Asia.
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Affiliation(s)
- Iqra Hussain
- School of Biological Sciences, University of the Punjab, Lahore, Pakistan
| | - Fareeda Tasneem
- Department of Zoology, University of the Punjab, Lahore, Pakistan
| | - Usman Shah Gilani
- School of Biological Sciences, University of the Punjab, Lahore, Pakistan
| | | | | | - Zaigham Abbas
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Muhammed Umer
- Queensland Micro- and Nanotechnology Centre (QMNC), Griffith University, Nathan, QLD, 4111, Australia
| | - Naveed Shahzad
- School of Biological Sciences, University of the Punjab, Lahore, Pakistan.
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6
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Hamasaki Y, Dolan NM, Cubitt D, Breuer J, Sebire NJ, Marks SD. BK viremia and nephropathy in pediatric renal transplant recipients. Pediatr Transplant 2019; 23:e13460. [PMID: 31273924 DOI: 10.1111/petr.13460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/28/2019] [Accepted: 04/03/2019] [Indexed: 12/17/2022]
Abstract
The renal survival rate of pediatric renal transplant recipients (pRTR) has improved with the use of modern immunosuppressive agents; however, the incidence of post-transplantation viral infection has increased. This study investigated the incidence of BK viremia and BK viral-associated nephropathy (BKVAN) in pRTR. One-hundred-and-thirty-four pRTR were divided into two groups: group 1 (n = 20, 14.9%) comprised those who were prospectively followed with longitudinal analyses after renal transplantation in the time period from May 2007 to June 2008, while group 2 (n = 114, 85.1%) cross-sectional study of those who were transplanted from January 1994 to April 2007. The mean ages at transplantation in groups 1 and 2 were 10.6 ± 4.7 years and 7.8 ± 4.5 years, respectively. BK viremia was detected in four (20.0%) patients in group 1, and seven (6.1%) in group 2 (P = 0.04), with increased incidence associated with induction therapy. The median time to detection of BK viremia after transplantation was 44 days in group 1 and 142 days in group 2. BKVAN was diagnosed in three patients (two in group 1 and one in group 2). All three patients diagnosed with BKVAN were receiving tacrolimus, mycophenolate mofetil, and corticosteroids as maintenance immunosuppression. Reducing immunosuppression resulted in reduced BK viremia. Monitoring for BK viremia and BKVAN is important in pRTR being treated with the current immunosuppressive regimen. The first line of treatment for BK viremia remains careful reduction of immunosuppression and close monitoring of renal allograft function.
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Affiliation(s)
- Yuko Hamasaki
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Niamh M Dolan
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - David Cubitt
- Department of Virology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Judith Breuer
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Neil J Sebire
- Department of Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stephen D Marks
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University College London, Great Ormond Street Institute of Child Health, London, UK
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7
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Devresse A, Tinel C, Vermorel A, Snanoudj R, Morin L, Avettand‐Fenoel V, Amrouche L, Scemla A, Zuber J, Legendre C, Rabant M, Anglicheau D. No clinical benefit of rapid versus gradual tapering of immunosuppression to treat sustained
BK
virus viremia after kidney transplantation: a single‐center experience. Transpl Int 2019; 32:481-492. [DOI: 10.1111/tri.13392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/22/2018] [Accepted: 12/13/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Arnaud Devresse
- Department of Nephrology and Kidney Transplantation Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- Division of Nephrology University Hospital Saint‐Luc Brussels Belgium
- Institute of Experimental and Clinical Research Catholic University of Louvain Brussels Belgium
| | - Claire Tinel
- Department of Nephrology and Kidney Transplantation Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- Necker‐Enfants Malades Institute French National Institute of Health and Medical Research U1151 Paris France
| | - Agathe Vermorel
- Necker‐Enfants Malades Institute French National Institute of Health and Medical Research U1151 Paris France
| | - Renaud Snanoudj
- Nephrology and Transplantation Department Foch Hospital Suresnes France
| | - Lise Morin
- Department of Nephrology and Kidney Transplantation Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - Véronique Avettand‐Fenoel
- Paris Descartes Sorbonne Paris Cité University Paris France
- Department of Virology Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - Lucile Amrouche
- Department of Nephrology and Kidney Transplantation Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- Paris Descartes Sorbonne Paris Cité University Paris France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- Paris Descartes Sorbonne Paris Cité University Paris France
| | - Marion Rabant
- Necker‐Enfants Malades Institute French National Institute of Health and Medical Research U1151 Paris France
- Paris Descartes Sorbonne Paris Cité University Paris France
- Pathology Department Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation Necker Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- Necker‐Enfants Malades Institute French National Institute of Health and Medical Research U1151 Paris France
- Paris Descartes Sorbonne Paris Cité University Paris France
- Centaure Foundation and Labex Transplantex Necker Hospital Paris France
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8
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Korth J, Widera M, Dolff S, Guberina H, Bienholz A, Brinkhoff A, Anastasiou OE, Kribben A, Dittmer U, Verheyen J, Wilde B, Witzke O. Impact of low-level BK polyomavirus viremia on intermediate-term renal allograft function. Transpl Infect Dis 2018; 20. [PMID: 29156086 DOI: 10.1111/tid.12817] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/10/2017] [Accepted: 08/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND BK polyomavirus (BKPyV)-associated nephropathy (PyVAN) is a significant cause of premature renal transplant failure. High-level BKPyV viremia is predictive for PyVAN; however, low-level BKPyV viremia does not necessarily exclude the presence of PyVAN. As data are limited regarding whether or not low-level BKPyV viremia has an effect on intermediate-term graft outcome, this study analyzes the impact of low-level BKPyV viremia on intermediate-term graft function and outcome compared with high-level viremia and non-viremic patients. METHODS All renal transplant patients received follow-up examinations at the Department of Nephrology, University Hospital Essen. Patients were screened for BKPyV viremia and stratified into three groups according to their maximum BKPyV load in serum (low-level viremia, high-level viremia, and no viremia). RESULTS In 142 of 213 (67%) patients, BKPyV was never detected in serum; 42 of 213 (20%) patients were found positive for low-level viremia (≤104 copies/mL); and 29 of 213 (13%) patients showed high-level viremia (>104 copies/mL). No significant differences regarding transplant function and graft failure were observed between patients without BKPyV viremia (delta estimated glomerular filtration rate [eGFR] +0.1 mL/min [month 1 vs last visit at month 44]) and patients with low-level BKPyV viremia (delta eGFR -1.7 mL/min). In patients with high-level viremia, transplant function was significantly restricted (delta eGFR -6.5 mL/min) compared with low-level viremia until the last visit at 44 ± 9.7 months after transplantation. Although the graft function and graft loss were worse in the high-level viremia group compared with no viremia (eGFR 37 vs 45 mL/min), the difference was not significant. CONCLUSIONS High-level viremia was associated with impaired graft function. In contrast, low-level BKPyV viremia had no significant impact on intermediate-term graft function.
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Affiliation(s)
- Johannes Korth
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marek Widera
- Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Hana Guberina
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Anja Bienholz
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Alexandra Brinkhoff
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Olympia Evdoxia Anastasiou
- Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Gastroenterology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ulf Dittmer
- Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jens Verheyen
- Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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9
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Bagchi S, Gopalakrishnan V, Srivastava SK, Upadhayay A, Singh G, Bhowmik D, Mahajan S, Dinda A, Agarwal SK. BK polyomavirus infection after renal transplantation: Surveillance in a resource-challenged setting. Transpl Infect Dis 2017; 19. [PMID: 28834032 DOI: 10.1111/tid.12770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/02/2017] [Accepted: 06/04/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is a paucity of data available about BK polyomavirus (BKPyV) infection after renal transplantation (RTX) in resource-limited countries with a predominantly living-donor, ABO-compatible RTX program. We aimed to assess BKPyV infection in such patients in a public hospital in India. METHODS We prospectively evaluated plasma BKPyV replication in 62 patients at 1, 3, 6, 9, and 12 months after RTX. Sustained significant BK viremia (SSBKV) was defined as significant viremia (≥10 000 copies/mL) detected ≥2 times, and BKPyV-associated nephropathy (BKVAN) as histologic changes of BKVAN with BK viremia with/without graft dysfunction. RESULTS All patients underwent RTX without requiring desensitization. Incidence of BK viremia was: 17.7%, 41.9%, 16.1%, 25.8%, and 17.7% at 1, 3, 6, 9, and 12 months, respectively. Of 62 patients, 64.5% had BKPyV viremia during the study, 32.2% had significant viremia, all except one detected in the first 6 months. Nine (14.5%) patients had SSBKV. There was no biopsy-proven BKVAN. At the end of 1 year, mean serum creatinine was higher and graft dysfunction was significantly more common in patients with SSBKV compared to those without SSBKV. CONCLUSION Transient BK viremia is common in low/intermediate immunologic risk RTX recipients in India, with a peak occurring at 3-6 months. Most clear their viremia by 12 months. Graft dysfunction seems to be more frequent in patients with SSBKV, although BKVAN is uncommon on biopsy in these patients.
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Affiliation(s)
- Soumita Bagchi
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Ashish Upadhayay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Geetika Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipankar Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Dinda
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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10
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Azar MM, Assi R, Valika AK, Banach DB, Hall IE, Landry ML, Malinis MF. Graft loss among renal-transplant recipients with early reduction of immunosuppression for BK viremia. World J Transplant 2017; 7:269-275. [PMID: 29104861 PMCID: PMC5661124 DOI: 10.5500/wjt.v7.i5.269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/28/2017] [Accepted: 08/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To review the incidence of graft loss and acute rejection among renal transplant recipients with early reduction of immunosuppression for BK viremia.
METHODS We performed a retrospective analysis of consecutive de-novo kidney-only transplants from January 2009 to December 2012 to evaluate the incidence of Polyoma-virus associated nephropathy (PyVAN). Recipient plasma was screened for BKV DNA via quantitative polymerase chain reaction (PCR) at months 1, 3, 6, 9 and 12 post-transplant and on worsening graft function. Immunosuppression was reduced at ≥ 3-log copies/mL. Those with viremia of ≥ 4-log copies/mL (presumptive PyVAN) underwent renal transplant biopsy. Presumptive PyVAN (PP) and definitive PyVAN (DP; biopsy-proven) were treated by immunosuppression reduction (IR) only.
RESULTS Among 319 kidney transplant recipients, the median age was 53 years (range 19-83), 65.8% were male, and 58.9% were white. Biopsy-proven acute rejection was found in 18.5% within 0-168 wk. Death-censored graft loss occurred in 5.3% (n = 17) and graft loss attributable to PyVAN was 0.6% (n = 2). Forty-seven patients were diagnosed with PP (14.7%) and 18 (5.6%) with DP. Graft loss among participants with PyVAN (8.5%) and those without (4.8%) was not significantly different. Deceased donor kidney transplantation (OR = 2.3, 95%CI = 1.1-4.6) and AR (OR = 2.3, 95%CI = 1.2-4.7) were associated with PyVAN in the multivariate analysis. BK viremia between 3 and 4-log copies/mL occurred in 27 patients, all of whom underwent IR. Of these, 16 (59%) never developed PyVAN while 11 (41%) developed PyVAN (4 DP, 7 PP) within a range of 11-39 wk.
CONCLUSION Instituting an early reduction of immunosuppression, in the absence of adjunctive antivirals, is effective at preventing PyVAN and may be associated with a lower incidence of graft-loss without a reciprocal increase in the incidence of acute rejection.
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Affiliation(s)
- Marwan M Azar
- Department of Pathology, Section of Microbiology, Massachusetts General Hospital, Boston, MA 02145, United States
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, United States
| | - Roland Assi
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Aziz K Valika
- Adventist Health Partners, Chicago, IL 60521, United States
| | - David B Banach
- Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, CT 06032, United States
| | - Isaac E Hall
- Division of Hypertension and Nephrology, University of Utah School of Medicine, Dalt Lake City, UT 84132, United States
| | - Marie-Louise Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Maricar F Malinis
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, United States
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States
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11
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Verghese PS, Schmeling DO, Filtz EA, Matas AJ, Balfour HH. The impact of recipient BKV shedding before transplant on BKV viruria, DNAemia, and nephropathy post-transplant: A prospective study. Pediatr Transplant 2017; 21:10.1111/petr.12942. [PMID: 28557148 PMCID: PMC5511090 DOI: 10.1111/petr.12942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2017] [Indexed: 12/20/2022]
Abstract
We previously demonstrated that detectable BKV replication in donor urine pretransplant was significantly associated with post-transplant recipient BKV viremia. In this 4-year prospective study, we assessed whether recipient BKV replication pretransplant was associated with post-transplant viremia/BKV nephropathy. We studied 220 primary adult and pediatric organ transplant recipients for 490 person-years and 2100 clinical visits. BKV viruria was detectable in 28 (16%), 26 adults and two children; and viremia in none pretransplant. Post-transplant viruria occurred in all recipients with pretransplant BKV viruria, significantly more than in recipients without pretransplant viruria on univariate (P<.005) and multivariate analysis including type of organ transplanted and immunosuppression type (P .008). Time to post-transplant viruria was significantly shorter in recipients with pretransplant viruria (P .01). By univariate and multivariate analysis, BKV viruria in recipients pretransplant did not impact post-transplant BKV viremia (P=.97 and .97, respectively) even when stratified by type of organ transplant (kidney P=.6; liver P=.5). The peak serum and urine BKV PCR post-transplant were not significantly different in patients with pretransplant BKV viruria and no one developed BK nephropathy. In conclusion, recipient BKV viruria prior to transplant predicts post-transplant viruria but not viremia or BKV nephropathy.
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Affiliation(s)
- PS Verghese
- Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN 55454, US
| | - DO Schmeling
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN 55454, US
| | - EA Filtz
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN 55454, US
| | - AJ Matas
- Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN 55454, US
| | - HH Balfour
- Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, MN 55454, US,Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN 55454, US
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12
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Viral Origin, Clinical Course, and Renal Outcomes in Patients With BK Virus Infection After Living-Donor Renal Transplantation. Transplantation 2016; 100:844-53. [PMID: 26720302 DOI: 10.1097/tp.0000000000001066] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND BK virus (BKV) nephropathy remains the main cause of renal graft loss after living-donor renal transplantation. The aim of the study was to investigate the source and factors influencing the course of BKV infection. METHODS We investigated 214 living donor-recipient pairs. Urine and blood of donors and recipients were tested by qPCR for the presence of BKV DNA before and after transplantation; genotyping of BKV subtypes was performed. RESULTS Eighty-five recipients (40%) had posttransplant BK viruria including 61 with additional viremia and 22 with nephropathy. Pretransplant urinary BKV shedding of donor or recipient was a significant risk factor for posttransplant viruria and viremia (OR, 4.52; CI, 2.33-8.77; P < 0.0001) and nephropathy (OR, 3.03; CI, 1.16-7.9; P = 0.02). In the BKV nephropathy group, urine and blood became BKV positive earlier than in the group with viruria and viremia. Renal function was worse in BKV-nephropathy compared with BKV-negative patients beginning at transplantation. Comparing BKV subtypes of donor and recipient before with the subtype of the infected recipient after transplantation, donor-derived transmission was identified in 24 of 28 corresponding pairs. BKV subtype IV had a higher prevalence in recipients with BKV nephropathy than in those with viruria and viremia (P = 0.045). CONCLUSIONS Pretransplant urinary BKV shedding of donor and recipient is a risk for posttransplant infection. Donor-derived BKV transmission is an important mode of infection. BKV subtype IV may be one of the viral determinants. Early BKV positivity of urine and blood indicates later BKV nephropathy. Decreased renal function may favor BKV infection.
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13
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Bicalho CS, Oliveira RR, Pierrotti LC, Fink MCDS, Urbano PRP, Nali LHS, Luna EJA, Romano CM, David DR, David-Neto E, Pannuti CS. Pre-transplant shedding of BK virus in urine is unrelated to post-transplant viruria and viremia in kidney transplant recipients. Clin Transplant 2016; 30:796-801. [DOI: 10.1111/ctr.12752] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 01/16/2023]
Affiliation(s)
- C. S. Bicalho
- Department of Infectious and Parasitic Diseases; University of São Paulo School of Medicine; Hospital das Clínicas; São Paulo Brazil
| | - R. R. Oliveira
- Virology Laboratory; São Paulo Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
| | - L. C. Pierrotti
- Department of Infectious and Parasitic Diseases; University of São Paulo School of Medicine; Hospital das Clínicas; São Paulo Brazil
| | - M. C. D. S. Fink
- Virology Laboratory; São Paulo Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
| | - P. R. P. Urbano
- Virology Laboratory; São Paulo Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
| | - L. H. S. Nali
- Virology Laboratory; São Paulo Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
| | - E. J. A. Luna
- Virology Laboratory; São Paulo Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
| | - C. M. Romano
- Virology Laboratory; São Paulo Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
| | - D. R. David
- Department of Pathology; University of São Paulo School of Medicine; São Paulo Brazil
| | - E. David-Neto
- Renal Transplant Division; University of São Paulo School of Medicine Hospital das Clínicas; São Paulo Brazil
| | - C. S. Pannuti
- Virology Laboratory; São Paulo Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
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14
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Abstract
BACKGROUND Reactivation of BK polyoma virus can result in destructive viral allograft nephropathy (BKVAN) with limited treatment options. Screening programs using surrogate markers of viral replication are important preventive strategies, guiding immunosuppression reduction. METHODS We prospectively evaluated the diagnostic test performance of urinary decoy cells and urinary SV40T immunochemistry of exfoliated cells, to screen for BKVAN, (defined by reference histology with SV40 immunohistochemistry, n = 704 samples), compared with quantitative viremia, from 211 kidney and 141 kidney-pancreas transplant recipients. RESULTS The disease prevalence of BKVAN was 2.6%. Decoy cells occurred in 95 of 704 (13.5%) samples, with a sensitivity of 66.7%, specificity of 88.6%, positive predictive value (PPV) of 11.7%, and negative predictive value of 98.5% to predict histologically proven BKVAN. Quantification of decoy cells improved the PPV to 32.1% (10 ≥ cells threshold). Immunohistochemical staining of urinary exfoliated cells for SV40T improved sensitivity to 85.7%, detecting atypical or degenerate infected cells (specificity of 92.3% and PPV of 33.3%), but was hampered by technical failures. Viremia occurred in 90 of 704 (12.8%) with sensitivity of 96.3%, specificity of 90.3%, PPV of 31.5%, and negative predictive value of 99.8%. The receiver-operator curve performance of quantitative viremia surpassed decoy cells (area under the curve of 0.95 and 0.79, respectively, P = 0.0018 for differences). Combining decoy cell and BK viremia in a diagnostic matrix improved prediction of BKVAN and diagnostic risk stratification, especially for high-level positive results. CONCLUSIONS Although quantified decoy cells are acceptable surrogate markers of BK viral replication with unexceptional test performances, quantitative viremia displayed superior test characteristics and is suggested as the screening test of choice.
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15
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Madhavan HN, Bagyalakshmi R, Revathy M, Aarthi P, Malathi J. Optimisation and analysis of polymerase chain reaction based DNA sequencing for genotyping polyoma virus in renal transplant patients: a report from South India. Indian J Med Microbiol 2015; 33 Suppl:37-42. [PMID: 25657154 DOI: 10.4103/0255-0857.150878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To optimise a polymerase chain reaction (PCR) based DNA sequencing technique for genotyping polyoma virus in clinical specimens obtained from renal transplant patients. MATERIALS AND METHODS A hundred and thirty (106 peripheral blood and 24 urine) clinical specimens collected from renal transplant patients were included in the study for detecting the presence of DNA of BK virus (BKV), JC virus (JCV) by PCR targeting the viral protein 1 (VP1) gene. PCR based DNA sequencing was performed to determine the genotypes of polyoma virus and subjected to bioinformatics analysis to determine the amino acid sequences and screen for mutations in the VP1 gene. RESULTS Polyoma virus was detected in 23 (17.69%) specimens of which 19 (82.60%) were positive for BK virus, 3 (13.04%) for JC virus and 1 for both BK and JC virus. PCR based DNA sequencing detected BK virus genotype I in 12 (50%), genotype IV in 8 (33.3%) and JC virus in 4 (16.6%) clinical specimens. BKV genotype I was the predominant genotype (64.2% in peripheral blood and 33.33% in urine) prevalent in south India. Six novel mutations were found--at position 29, 30 to 47 of BKV genotype I; at position 11 and 15 of BKV genotype IV and at position 2 and 30 of JCV. CONCLUSION BKV genotype I is the prominent genotype in India and novel mutations detected in the VP1 gene of BKV and JCV are being reported for the first time in literature.
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Affiliation(s)
- H N Madhavan
- L and T, Larsen and Toubro Microbiology Research Centre, Kamal Nayan Bajaj Research Centre, Vision Research Foundation, Chennai, Tamil Nadu, India
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16
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Boukoum H, Nahdi I, Sahtout W, Skiri H, Aloui S, Achour A, Segondy M, Aouni M. BK and JC polyomavirus infections in Tunisian renal transplant recipients. J Med Virol 2015; 87:1788-95. [DOI: 10.1002/jmv.24234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Hanen Boukoum
- Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives; LR-99ES27; Faculté de Pharmacie; Monastir Tunisia
| | - Imen Nahdi
- Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives; LR-99ES27; Faculté de Pharmacie; Monastir Tunisia
| | | | - Habib Skiri
- Service de Néphrologie; Hôpital Fattouma Borguiba; Monastir Tunisia
| | - Sabra Aloui
- Service de Néphrologie; Hôpital Fattouma Borguiba; Monastir Tunisia
| | | | - Michel Segondy
- Laboratoire de Virologie; CHU de Montpellier; Université de Montpellier I; hôpital Saint-Éloi; Montpellier France
| | - Mahjoub Aouni
- Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives; LR-99ES27; Faculté de Pharmacie; Monastir Tunisia
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17
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Sawinski D, Forde KA, Trofe-Clark J, Patel P, Olivera B, Goral S, Bloom RD. Persistent BK viremia does not increase intermediate-term graft loss but is associated with de novo donor-specific antibodies. J Am Soc Nephrol 2014; 26:966-75. [PMID: 25255921 DOI: 10.1681/asn.2014010119] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There are limited data regarding intermediate-term outcomes in patients with persistent BK viremia. Other viral infections have been implicated in the development of allosensitization through heterologous immunity, but the relationship between BK viremia and donor-specific antibodies (DSAs) is unexplored. In 2008, we initiated routine post-transplant BK viremia and DSA screening at our center; 785 kidney or kidney-pancreas transplant recipients were included in our study. Of these recipients, 132 (17%) recipients developed BK viremia during the study period. The median duration of BK viremia was 140 days (interquartile range=40-393 days), and persistent BK viremia was defined as lasting ≥140 days. Kaplan-Meier curves were generated to assess differences in patient and allograft survival on the basis of BK viremia status; survival was modeled using Cox proportional hazard regression. After a median follow-up of 3 years, there was no significant difference in terms of patient (hazard ratio [HR], 0.83; 95% confidence interval [95% CI], 0.28 to 2.49) or allograft survival (HR, 0.80; 95% CI, 0.37 to 1.73) between patients with and without BK viremia, which was confirmed in a time-varying analysis. In our logistic regression model, persistent BK viremia was strongly associated with the development of class II (HR, 2.55; 95% CI, 1.30 to 4.98) but not class I (HR, 1.13; 95% CI, 0.46 to 2.77) DSAs. These data suggest that persistent BK viremia does not negatively affect intermediate-term patient or allograft survival but is associated with increased risk for de novo DSA, although the exact mechanism is unclear.
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Affiliation(s)
- Deirdre Sawinski
- Department of Medicine, Renal Electrolyte and Hypertension Division,
| | - Kimberly A Forde
- Department of Medicine, Gastroenterology Division, and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Jennifer Trofe-Clark
- Department of Medicine, Renal Electrolyte and Hypertension Division, Department of Pharmacy Services, Hospital of the University of Pennsylvania Philadelphia, Pennsylvania
| | - Priyanka Patel
- Department of Medicine, Renal Electrolyte and Hypertension Division
| | - Beatriz Olivera
- Department of Medicine, Renal Electrolyte and Hypertension Division
| | - Simin Goral
- Department of Medicine, Renal Electrolyte and Hypertension Division
| | - Roy D Bloom
- Department of Medicine, Renal Electrolyte and Hypertension Division
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18
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Sawinski D, Goral S. BK virus infection: an update on diagnosis and treatment. Nephrol Dial Transplant 2014; 30:209-17. [PMID: 24574543 DOI: 10.1093/ndt/gfu023] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BK virus, first isolated in 1971, is a significant risk factor for renal transplant dysfunction and allograft loss. Unfortunately, treatment options for BK virus infection are limited, and there is no effective prophylaxis. Although overimmunosuppression remains the primary risk factor for BK infection after transplantation, male gender, older recipient age, prior rejection episodes, degree of human leukocyte antigen mismatching, prolonged cold ischemia time, BK serostatus and ureteral stent placement have all been implicated as risk factors. Routine screening for BK has been shown to be effective in preventing allograft loss in patients with BK viruria or viremia. Reduction of immunosuppression remains the mainstay of BK nephropathy treatment and is the best studied intervention. Laboratory-based methods such as ELISPOT assays have provided new insights into the immune response to BK and may help guide therapy in the future. In this review, we will discuss the epidemiology of BK virus infection, screening strategies, treatment options and future research directions.
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Affiliation(s)
- Deirdre Sawinski
- Renal, Electrolyte, and Hypertension Division, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Simin Goral
- Renal, Electrolyte, and Hypertension Division, University of Pennsylvania Medical Center, Philadelphia, PA, USA
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19
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Mitterhofer AP, Tinti F, Pietropaolo V, Umbro I, Anzivino E, Bellizzi A, Zavatto A, Poli L, Berloco PB, Taliani G. Role of BK virus infection in end-stage renal disease patients waiting for kidney transplantation - viral replication dynamics from pre- to post-transplant. Clin Transplant 2014; 28:299-306. [DOI: 10.1111/ctr.12312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Anna Paola Mitterhofer
- Nephrology and Dialysis Unit; Department of Clinical Medicine; Sapienza University of Rome; Rome Italy
| | - Francesca Tinti
- Nephrology and Dialysis Unit; Department of Clinical Medicine; Sapienza University of Rome; Rome Italy
| | - Valeria Pietropaolo
- Department of Public Health and Infectious Diseases; Sapienza University of Rome; Rome Italy
| | - Ilaria Umbro
- Nephrology and Dialysis Unit; Department of Clinical Medicine; Sapienza University of Rome; Rome Italy
| | - Elena Anzivino
- Department of Obstetrics, Gynecology and Urological Sciences; Sapienza University of Rome; Rome Italy
| | - Anna Bellizzi
- Department of Public Health and Infectious Diseases; Sapienza University of Rome; Rome Italy
| | - Assunta Zavatto
- Nephrology and Dialysis Unit; Department of Clinical Medicine; Sapienza University of Rome; Rome Italy
| | - Luca Poli
- Organ Transplant Unit “Paride Stefanini”; Department of General Surgery; Sapienza University of Rome; Rome Italy
| | - Pasquale Bartolomeo Berloco
- Organ Transplant Unit “Paride Stefanini”; Department of General Surgery; Sapienza University of Rome; Rome Italy
| | - Gloria Taliani
- Department of Infectious and Tropical Diseases; Sapienza University of Rome; Rome Italy
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Balba GP, Javaid B, Timpone JG. BK Polyomavirus Infection in the Renal Transplant Recipient. Infect Dis Clin North Am 2013; 27:271-83. [DOI: 10.1016/j.idc.2013.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Thakur R, Joshi K, Minz M, Singla A, Nada R, Arora S, Jha V, Sakhuja V. Dual Positivity of Donor and Recipient Plasma for BK Virus Confers a High Risk for Development of BK Nephropathy in Renal Allograft. Transplant Proc 2012; 44:717-20. [DOI: 10.1016/j.transproceed.2011.11.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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