BK polyoma virus infection and renal disease in non-renal solid organ transplantation

Kuppachi, Sarat; Kaur, Deepkamal; Holanda, Danniele G.; Thomas, Christie P.

doi:10.1093/ckj/sfv143

Cited by 23 publications

(23 citation statements)

References 87 publications

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“…Reactivation causes BKPyV replication within infected renal tubular cells, which is detectable by PCR in blood and urine. Unchecked BKPyV replication causes cytopathic changes in tubular cells and the inflammatory response causes BKPyVN in kidney transplant recipients and less often in NRSOT recipients .…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of BKPyV DNAemia and BKPyVN in recipients of nonrenal solid organ transplantation (NRSOT) is reported to be much lower. However, it is likely that BKPyVN is often not recognized in NRSOT recipients . We report a lung transplant recipient who developed BKPyVN in his native kidneys and who subsequently achieved a significant reduction in BKPyV DNAemia with stabilization of kidney function.…”

Section: Introductionmentioning

confidence: 92%

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An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy

Kuppachi

Holanda

Eberlein

et al. 2017

American Journal of Transplantation

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We report a lung transplant recipient who developed BK polyoma virus (BKPyV) DNAemia and BKPyV nephropathy. With careful management of his immunosuppression he achieved significant reduction in BKPyV DNAemia and stabilization of his kidney function. He later developed a high-grade bladder cancer and shortly thereafter he experienced a major upsurge in the level of BKPyV DNAemia that coincided with the discovery of hepatic metastasis. Retrospectively, the bladder cancer and the hepatic secondary tumor stained uniformly for SV40 large T antigen, and the BKPyV DNA sequences identified in plasma corresponded to BKPyV DNA within hepatic tissue, indicating that the spike in BKPyV load was likely derived from the circulating tumor cells or cell-free tumor DNA following metastases of a BKV-associated cancer. To the best of our knowledge, this is the first description of a surge in BKPyV load in a patient with controlled BKPyVN that heralded the appearance of a metastatic urothelial malignancy. This report discusses the literature on BKPyV-associated malignancies and the possibility that unexplained increases in BKPyV DNAemia may be a biomarker for metastatic BKPyV-related urothelial cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy

Kuppachi

Holanda

Eberlein

et al. 2017

American Journal of Transplantation

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“…As only 32 (14.5%) patients had less than 1 year post-transplant follow-up, and loss to follow-up was patient death/ graft loss in the majority, we believe it is unlikely that a differential biologic effect in the frequency of progression to BKV nephropathy was missed given that BKV nephropathy is largely recognized as an early event occurring within the first year after transplantation. 16,17 BKV viruria in the absence of BKV viremia is not usually associated with an increased risk for BKV disease, 18 although in patients with BKV nephropathy, it is often preceded by viruria and then viremia. 17 In our patients, viruria did not predict viremia or nephropathy.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 BKV viruria in the absence of BKV viremia is not usually associated with an increased risk for BKV disease, 18 although in patients with BKV nephropathy, it is often preceded by viruria and then viremia. 17 In our patients, viruria did not predict viremia or nephropathy. We conclude that despite the association of recipient BK viruria pre-and post- While the lack of BKV antibody data in our study is unfortunate, BKV antibody testing is not routinely carried out at most centers including ours.…”

Section: Discussionmentioning

confidence: 99%

The impact of recipient BKV shedding before transplant on BKV viruria, DNAemia, and nephropathy post‐transplant: A prospective study

Verghese

Schmeling

Filtz

et al. 2017

Pediatric Transplantation

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We previously demonstrated that detectable BK virus (BKV) replication in donor urine pre- transplant was significantly associated with post-transplant recipient BKV viremia. In this 4-year prospective study, we assessed whether recipient BKV replication pre-transplant 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 2 children; and viremia in none pre- transplant. Post-transplant viruria occurred in all recipients with pre-transplant BKV viruria; significantly more than in recipients without pre-transplant viruria on univariate (p <0.005) and multivariate analysis including type of organ transplanted and immunosuppression type (p 0.008). Time to post-transplant viruria was significantly shorter in recipients with pre-transplant viruria (p 0.01). By univariate and multivariate analysis, BKV viruria in recipients pre-transplant did not impact post-transplant BKV viremia (p=0.97 and 0.97 respectively) even when stratified by type of organ transplant (kidney p=0.6; liver p=0.5). The peak serum and urine BKV PCR post-transplant was not significantly different in patients with pre-transplant 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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“…Therefore, the total load of immunosuppressive drugs may be the most important risk factor (Bassil et al 2014). Although the incidence of viremia is higher in heart transplant recipients than recipients of other organs (with the exception of kidney recipients), BKV replication appears to be a complication that predominantly affects kidney transplant recipients; therefore, the immunosuppression intensity may not be solely responsible (Mbianda et al 2015, Viswesh et al 2015, Kuppachi et al 2016.…”

mentioning

confidence: 99%

Evaluation of the predisposition and clinical impact of BK virus replication in kidney transplant patients

Moura

Petzhold

Amaral

et al. 2017

An. Acad. Bras. Ciênc.

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The BK virus (BKV) produces a subclinical kidney infection in immunocompetent individuals. However, viremia may occur in kidney transplant patients with ongoing immunosuppression. BKV-associated nephropathy (BKVN) has no specific treatment and is a leading cause of organ transplant loss. In this study, we evaluated the predisposition and the clinical impact of BKV replication in kidney transplant patients during post-transplant monitoring in a reference institution in Brazil. Demographic, clinical and laboratory data generated during routine outpatient follow-up were retrospectively collected. BK viremia was investigated using real-time polymerase chain reaction. Of the 553 participants, 7.4% (n = 41) presented BKV replication. Of these, 16 (39%) lost their kidney graft and interstitial nephritis was identified on kidney biopsy in 50% of the cases. Among the evaluated variables, only the use of the immunosuppressant mycophenolate sodium was identified as a risk factor for viremia (OR 7.96; 95% CI 2.35 to 26.98). The graft survival estimate in BKV-positive patients was significantly reduced (24.8% vs. 85.6%) after 10 years of transplantation. We concluded that defining predisposing factors remains an important challenge for the prevention and control of BKV activity following kidney transplantation, especially considering the development of BKVN and its strong effect on graft maintenance.

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BK polyoma virus infection and renal disease in non-renal solid organ transplantation

Cited by 23 publications

References 87 publications

An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy

An Unexpected Surge in Plasma BKPyV Viral Load Heralds the Development of BKPyV-Associated Metastatic Bladder Cancer in a Lung Transplant Recipient With BKPyV Nephropathy

The impact of recipient BKV shedding before transplant on BKV viruria, DNAemia, and nephropathy post‐transplant: A prospective study

Evaluation of the predisposition and clinical impact of BK virus replication in kidney transplant patients

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