Detection of BK polyomavirus genotypes to predict the development of BK polyomavirus‐associated complications in kidney transplant recipients: A retrospective analysis

Abstract

Objectives: This study focused on the role that BK polyomavirus (BKPyV) genotypes can play in the development of BKPyV-associated complications in renal transplant recipients. Methods: A retrospective observational study (January 2015 to April 2018) was conducted by analyzing BKPyV genotypes in 180 blood samples with detectable BKPyV viral load (VL) > 1000 copies/mL, from 63 renal transplant recipients. VL and BKPyV genotypes detections were based on real-time PCR (rt-PCR)-specific assays. Results: Forty-four patients (44/63 [69.8%]) were men, and the median age was 55.0 (interquartile range 49.0-66.0 years). Eleven patients had clinical manifestations (11/63 [17.5%]). The most frequently detected genotypes were I (14/63 [22.2%]) and II (13/63 [20.6%]). Half of the patients (33/63 [52.4%]) had a mixed genotype, most with genotypes I and II (25/33 [75.8%]). Patients with infection by mixed genotypesshowed VLs that were detected earlier (in the first year after transplantation) than those with a single genotype (25/33 [75.8%] vs 13/30 [43.3%], P = .009) and demonstrated greater risk of developing clinical manifestations associated with BKPyV (odds ratio 12.609, 95% confidence interval 1.503-105.807). Moreover, patients with first BKPyV VL > 10 000 copies/mL more frequently presented mixed genotypes (12/16 [75.0%] vs 21/47 [44.7%], P = .036). Conclusions:The probability of developing clinical manifestations is higher in infections by mixed genotypes. Therefore, the detection of BKPyV genotypes by rt-PCR can provide relevant information to stratify patients' risk of BKPyV-associated complications and guide the clinical management of BKPyV infection in kidney transplant recipients.

A cluster of BK polyomavirus‐associated hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

“…1 BKV can cause serious complications, such as hemorrhagic cystitis (HC) after hematopoietic stem cell transplantation (HSCT) and BKV-associated nephropathy due to allograft loss after renal transplantation. [1][2][3][4] The frequency of BKV-associated HC (BKV-HC) after HSCT is ∼10%. 1,2 BKV-HC reduces patients' quality of life and may lead to decreased overall survival.…”

“…BK polyomavirus (BKV) infects most of the general population during childhood and persists in renal tubular cells and urothelial cells 1 . BKV can cause serious complications, such as hemorrhagic cystitis (HC) after hematopoietic stem cell transplantation (HSCT) and BKV‐associated nephropathy due to allograft loss after renal transplantation 1–4 . The frequency of BKV‐associated HC (BKV‐HC) after HSCT is ∼10% 1,2 .…”

Genotypes and Variants of BKPyV in Organ Donors after Brain Death

“…The analysis of the sequences revealed co-infection with genotypes I and IV in 8% of DBDs (4/49). Co-infections with different genotypes have previously been described by Muñoz-Gallego et al [ 41 ], who observed mixed genotypes in more than half of patients tested (33/63), among which the most common was the combination of genotypes I and II. The researchers noted that patients with mixed genotypes developed a detectable BKPyV viral load in blood (VL > 1000 copies/mL) more rapidly and had a greater risk of clinical manifestations associated with BKPyV infection.…”

BK virus genotypes and humoral response in kidney transplant recipients with BKV associated nephropathy

“…Interestingly, we found a high prevalence of BKV-II subtype (25% of BKVN diagnostic samples), which had already been found in another recent study in Spain. 27 This may be due to the fact that almost a third of our study population originated from Africa, a region where the prevalence of BKV-II is higher compared to Europe, Northern America, or Asia. 7 Moreover, VP1 sequencing identified the same BKV-subtype in all plasma samples, from the onset of BK viremia to BKVN.…”