Screening to Prevent Polyoma Virus Nephropathy in Kidney Transplantation: A Cost Analysis

Smith, Frank M.; Panek, Romuald; Kiberd, Bryce A.

doi:10.1111/j.1600-6143.2009.02729.x

Cited by 28 publications

(22 citation statements)

References 4 publications

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“…Other recent data support our approach to screening [8]. Smith et al [9] used decoy cells for urine detection rather than PCR. All of our patients received induction; thus, viremic and nonviremic patients cannot be separated on this basis.…”

Section: Discussionmentioning

confidence: 57%

Surveillance and Modification of Immunosuppression Minimizes BK Virus Nephropathy

Bennett

Meyer²,

Ridenour³

et al. 2010

Am J Nephrol

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Background/Aims: Infection of a transplanted kidney with the polyomavirus, BK, is associated with poor allograft survival. Methods: In an attempt to prevent this transplant complication, we studied 144 consecutive transplant recipients for the presence of BK infection with plasma and urine PCR testing at 1, 2, 3, 6 and 12 months. Viruria alone was followed by serial studies. If plasma PCR became positive at >2.6 log copies, mycophenolate was reduced until there was no detectable plasma viral load. Results: Urine PCR was positive in 34 (24%), while plasma PCR turned positive in 22 cases (15%). No patients developed viremia with <6.8 log copies in the urine. Viremia resolved within 3 months or less in 20 of 22 patients after reduction of immunosuppression. Surveillance biopsies at 2 and 6 months revealed no BK nephropathy. Eight patients had acute rejection during reduced immunosuppression; however, all of these reversed with pulse steroids. Patient and graft survival at 1 year was 99 and 98%, respectively. Use of the cell-mediated immunity assay (ImmuKnow®, Columbia, Md., USA) was not useful in identifying infected patients. Conclusion: Active surveillance for BK virus by urine/plasma PCR with prompt reduction in immunosuppression can prevent BK nephropathy.

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Section: Discussionmentioning

confidence: 57%

Surveillance and Modification of Immunosuppression Minimizes BK Virus Nephropathy

Bennett

Meyer²,

Ridenour³

et al. 2010

Am J Nephrol

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“…Screening for decoy cells in the urine first may be a cheaper option[33], but there is a high prevalence rate of BK viruria even in immunocompetent adults and not all centres have resources to perform this test. Though cost saving can be achieved by reductions of immunosuppression as described in the literature[38,39], they may not necessarily cover the cost of screening for BKV if immunosuppressants are inexpensive. To reduce the financial burden by increasing the monitoring interval to every 3 mo or longer, it may not reduce the incidence of BKVN as seen in the other studies.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of renal transplant recipients with BK virus infection and BK virus surveillance in the Auckland region from 2006 to 2012

Hsiao¹,

Pilmore²,

Zhou³

et al. 2016

WJN

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AIMTo evaluate incidence, risk factors and treatment outcome of BK polyomavirus nephropathy (BKVN) in a cohort of renal transplant recipients in the Auckland region without a formal BK polyomavirus (BKV) surveillance programme.METHODSA cohort of 226 patients who received their renal transplants from 2006 to 2012 was retrospectively reviewed.RESULTSSeventy-six recipients (33.6%) had a BK viral load (BKVL) test and 9 patients (3.9%) developed BKVN. Cold ischaemia time (HR = 1.18, 95%CI: 1.04-1.35) was found to be a risk factor for BKVN. Four recipients with BKVN had complete resolution of their BKV infection; 1 recipient had BKVL less than 625 copies/mL; 3 recipients had BKVL more than 1000 copies/mL and 1 had graft failure from BKVN. BKVN has a negative impact on graft function [median estimated glomerular filtration rate (eGFR) 22.5 (IQR 18.5-53.0) mL/min per 1.73 m2, P = 0.015), but no statistically significant difference (P = 0.374) in renal allograft function was found among negative BK viraemia group [median eGFR 60.0 (IQR 48.5-74.2) mL/min per 1.73 m2), positive BK viraemia without BKVN group [median eGFR 55.0 (IQR 47.0-76.0) mL/min per 1.73 m2] and unknown BKV status group [median eGFR 54.0 (IQR 43.8-71.0) mL/min per 1.73 m2]. The incidence and treatment outcomes of BKVN were similar to some centres with BKV surveillance programmes.CONCLUSIONRecipients with BVKN have poorer graft function. Although active surveillance for BKV has been shown to be effective in reducing incidence of BKVN, it should be tailored specifically to that transplant centre based on its epidemiology and outcomes of BKVN, particularly in centres with limited resources.

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“…However, in this study, there was no fixed BKV screening protocol, and a wide range was explored in their sensitivity analysis. Smith et al [21] have performed a cost analysis for sequential screening test. It has been illustrated that reduction in immunosuppressant covers the cost of screening for polyoma viral infection.…”

Section: Discussionmentioning

confidence: 99%

Screening Algorithm for BK Virus-Associated Nephropathy Using Sequential Testing of Urinary Cytology: A Probabilistic Model Analysis

K.M.

Leung²,

Lo³

et al. 2015

Am J Nephrol

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Background: Incorporating urinary cytology in BK virus (BKV) screening algorithm potentially reduces the screening cost for BK viral nephropathy. We aimed to evaluate the test performances and screening cost of sequential 2-stage screening consisting of urine cytology followed by BKV serum quantitative polymerase chain reaction (PCR). Methods: Ninety-five kidney transplant recipients who had BKV serum quantitative PCR/urine cytology tested and verified with histopathology (the reference gold standard) were included. A probabilistic model was constructed to evaluate the test performance and screening cost of 2-stage screening, and was compared with screening with urine cytology or serum viral load alone. Results: At a viral load threshold of ≥10⁴ copies/ml, the sensitivity and specificity of quantitative PCR alone were 83% (95% CI 69-96) and 91% (95% CI 83-97), respectively. The sensitivity and specificity of urine cytology alone were 91% (95% CI 79-100) and 74% (95% CI 60-91), respectively. Sequential 2-stage screening resulted in loss in sensitivity but a net gain in specificity (viral load threshold ≥10⁴ copies/ml - sensitivity, 75% (95% CI 60-91); specificity, 98% (95% CI 95-99)). Two-stage screening also had superior positive predictive value and is cost effective when BKV-associated nephropathy prevalence is below 94%. Conclusions: Our study had demonstrated a favorable test performance and cost efficiency of 2-stage BKV screening.

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Screening to Prevent Polyoma Virus Nephropathy in Kidney Transplantation: A Cost Analysis

Cited by 28 publications

References 4 publications

Surveillance and Modification of Immunosuppression Minimizes BK Virus Nephropathy

Surveillance and Modification of Immunosuppression Minimizes BK Virus Nephropathy

Outcomes of renal transplant recipients with BK virus infection and BK virus surveillance in the Auckland region from 2006 to 2012

Screening Algorithm for BK Virus-Associated Nephropathy Using Sequential Testing of Urinary Cytology: A Probabilistic Model Analysis

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