Bk Virus Infection in Association With Post-Transplant Urothelial Carcinoma

Abstract

Cyclosporine based regimen and 28 patients received Tacrolimus based regimen) since 1993. To minimize the risk of humoral rejection, we performed a splenectomy 2 weeks before transplantation, eliminated anti-A and/or anti-B antibodies by double-fi ltration plasmapheresis (DFPP), and administered a potent immunosuppressive regimen consisting of cyclophosphamide, anti-CD25 monoclonal antibody, calcineurin inhibitor and prednisolone. The calcineurin inhibitor dose was adjusted by monitoring AUC0-4 target values. We have performed BK virus follow-up in all patients since 2005. BK virus DNA detection in blood samples was performed using the quantitative real time polymerase chain reaction (PCR) technique. The primers used for this assay are specifi c for BK virus and have been designed to accommodate mutated strains. The range of detection is 1x1000 copies/ƒÊL. We investigated the incidence of BK virus infection between ABOi LDRT and ABO-compatible renal transplantation group (n=120). Results: The incidence of BK virus infection after transplantation was 1.1% (1/88) in the ABOi LDRT group as compared with 5.0% (6/120) in the ABO-compatible renal group (p=0.127). The incidence of acute rejection during the fi rst 3 months after transplantation was 18.2% @(8 cellular, 1 combined type and 7 antibodymediated rejection) in ABOi LDRT group, as compared with 20.8% (25/120) in the ABO-compatible group (p=0.634). Graft survival rates were similar in both groups (95.6% vs 96.3%) at 1 year (p=0.296). There are 4 patients with BKVN in ABO-compatible renal group, but no patient in ABOi LRT group. Conclusion: Although total immunosuppression might be generally potent in ABOi LDRT, Our center protocol of ABO-incompatible renal transplantation is not a risk factor for BK virus infection or BKVAN.

Archetype and Rearranged Non-coding Control Regions in Urothelial Bladder Carcinoma of Immunocompetent Individuals

“…Furthermore, a statistically significant association between urine cytological evidence of PyV infection (decoy cells) and BC was also demonstrated in immunocompetent patients (18). Despite this experimental and epidemiological evidence, clinical cases of PyV-associated urological malignancies are rare and presented mainly as isolated case reports, mostly in transplant recipients or rarely in immunocompetent patients (17,(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52).…”

High grade urothelial carcinoma in kidney transplant patients with a history of BK viremia – Just a coincidence?

“…Kidney transplant recipients (KTR) have been shown to have a three to four fold increased risk of developing urothelial carcinoma (UC) compared with the general population 1 and UC has been shown to be the most common malignancy in KTR apart from skin malignancies 2,3 . There have been a number of case reports of patients developing UC following kidney transplantation and BK polyoma virus (BKV) infection 4–13 and a large case series examining the development of malignancy in KTR which highlighted BKV infection and smoking as independent risk factors for the development of UC 2 . Primary BKV infection occurs almost universally in childhood.…”

Urothelial cell carcinoma after BK polyomavirus infection in kidney transplant recipients: A cohort study of veterans

“…A plethora of case reports and case series since 2002 have described KTR with incident cases of UCC after BKPyV infection . However, the first population‐based study to examine the relationship between BKPyV and UCC in KTR was only recently published by Liu et al .…”

“…A plethora of case reports and case series since 2002 have described KTR with incident cases of UCC after BKPyV infection. 10,11,[18][19][20][21][22][23][24][25][26][27][28][29][30] However, the first population-based study to examine the relationship between BKPyV and UCC in KTR was only recently published by Liu et al 31 This study was designed as a retrospective single-center case-control analysis of KTR, and found the relative risk of developing UCC in BKPyV-positive cases was 11.6 (95% confidence interval [CI]: 2.2-211) compared to their BKPyV-negative matched controls. One potential critique of this otherwise well-designed study is that the presence of decoy cells on urine cytology was considered as sufficient criteria for inclusion as a BKPyV-positive case, rather than requiring more direct evidence of BKPyV infection such as the presence of BKPyV in urine or blood.…”