A Qualitative Seminested PCR Assay as an Alternative to Urine Cytology for BK Polyomavirus Screening after Renal Transplantation

Abstract

Objective: Polyomavirus-associated nephropathy (PVAN) is a major cause of graft dysfunction after kidney transplantation. Therefore, routine screening for BK polyomavirus (BKV) infection with urine cytology or quantitative PCR-based assays has been recommended. Although less expensive than quantitative tests, qualitative PCR assays are not recommended for screening based on the assumption that their diagnostic accuracy is inferior to urine cytology. However, studies comparing the performance of both methods are scarce. Methods: We compared the accuracy between a qualitative seminested PCR (snPCR) assay and urine cytology for the screening of BKV viruria in 104 renal transplant recipients. Results: The snPCR assay was more sensitive than cytology (100 and 61%, respectively), yielding better negative predictive value (100 vs. 90%). In 7 (39%) of the 18 PVAN cases, BKV infection was detected exclusively by snPCR. Although the specificity of snPCR (63%) was lower than cytology (74%), their positive predictive values were similar (36 vs. 33%, respectively). In ROC curve analysis, the accuracy of snPCR was significantly higher (p = 0.03). Conclusion: This qualitative snPCR assay was more accurate than urine cytology for the detection of BKV viruria in renal transplant patients.

Quantitative detection of BK virus in kidney transplant recipients: a prospective validation study

“…At nine months post-transplantation, 32.5% of patients were found to have BKV viremia, but only 8 (4%) developed BKVAN. Previous studies performed in Brazil showed higher frequencies of BKVAN in kidney transplant recipient, 20 , 21 which may be related to differences in screening strategy (e.g., urinary decoy cells to trigger additional urine/plasma sampling for qPCR), in addition to regular biopsies, and ischemia times. The most relevant implication of BKV infection in renal transplant recipients relies on its ability to lead to graft fibrosis, which can be followed by renal dysfunction and eventually lead to graft loss.…”

Determining host factors contributing to the reactivation of JC virus in kidney transplant recipients

“…Nevertheless, the impact of Tacrolimus medication on JC viral load might not be virtual and, perhaps it is due to the low number of patients treated with this drug in our study. The correlation between sex and replication of polyomaviruses has been mentioned by some scientists [ 51 ]. In this study, we also showed that males had a higher chance of JCV viruria than females.…”

JC and BK virus DNA detection in archival slides of urine cytospin from renal transplant patients

“…The presence of decoy cells is a sensitive (100%) measure but has a low positive predictive value of 29% for diagnosing NBKV . Semi‐nested PCR (snPCR) was used to compare urine cytology for screening of BKV viruria, and the authors found that qualitative snPCR assay was more accurate than urine cytology in detecting BKV viruria in renal transplant patients . In our study, through a comparison of urine cytology with a molecular approach (PCR), 24/44 (54.5%) patients presented Polyomavirus infection.…”