Treatment for presumed BK polyomavirus nephropathy and risk of urinary tract cancers among kidney transplant recipients in the United States

Abstract

Recent case series describe detection of BK polyomavirus (BKV) in urinary tract cancers in kidney transplant recipients, suggesting that BKV could contribute to the development of these cancers. We assessed risk for urinary tract cancers in kidney recipients with or without treatment for presumed BKV nephropathy (tBKVN) using data from the United States Transplant Cancer Match Study (2003-2013). Among 55 697 included recipients, 2015 (3.6%) were reported with tBKVN. Relative to the general population, incidence was similarly elevated (approximately 4.5-fold) for kidney cancer in recipients with or without tBKVN, and incidence was not increased in either group for prostate cancer. In contrast, for invasive bladder cancer, incidence was more strongly elevated in recipients with versus without tBKVN (standardized incidence ratios 4.5 vs. 1.7; N = 48 cases), corresponding to an incidence rate ratio (IRR) of 2.9 (95% confidence interval [CI] 1.0-8.2), adjusted for sex, age, transplant year, and use of polyclonal antibody induction. As a result, recipients with tBKVN had borderline increased incidence for all urothelial cancers combined (renal pelvis, ureter, and bladder cancers: adjusted IRR 2.2, 95% CI 0.9-5.4; N = 89 cases). Together with reports describing BKV detection in tumor tissues, these results support an association between BKV and urothelial carcinogenesis among kidney transplant recipients.

High-grade urothelial carcinoma in a kidney transplant recipient after JC virus nephropathy: The first evidence of JC virus as a potential oncovirus in bladder cancer

“…The risk of urinary tract cancers in patients with KT was recently evaluated. The incidence of invasive bladder cancer was higher in patients with BKV nephropathy, with an incidence rate ratio of 2.9 (95% confidence interval 1.0‐8.2) . This finding, together with previous published cases of renourinary tumors after BKV nephropathy, support an association between polyomavirus and urothelial malignancy in immunosuppressed patients.…”

“…KT recipients are at an increased risk for urothelial carcinoma. [4][5][6][7][8] Infection with oncogenic viruses could be a plausible explanation.…”

“…3KT recipients are at an increased risk for urothelial carcinoma. [4][5][6][7][8] Infection with oncogenic viruses could be a plausible explanation.Based on experimental models, JCV inoculation in cells that do not support viral replication leads to cancer formation. 9 Thus, human polyomaviruses have recently been categorized as "possible carcinogens" by the International Agency for Research in Cancer, 10 although a role for JCV in human cancers is not yet proved.…”

Unusual BK polyomavirus‐associated urologic malignancies in renal transplant recipients: Report of two cases and review of the literature

“…Kidney transplantation (KT) is the only definitive treatment for patients with end‐stage renal disease (ESRD), which affects 30 million adults in the United States . While KT significantly improves the quality of life of ESRD patients, it also increases their risk of developing malignancies, and in particular urologic malignancies, for which smoking and BK virus (BKV) infection are known risk factors . Herein, we report two cases of BKV‐associated urologic malignancy in KT recipients and review the literature with special emphasis on the cytologic features of this malignancy.…”

“…A minority (17/36) of reported BKV-associated urologic malignancies had a preceding/concurrent urine cytology evaluation, which was reported as "positive for carcinoma" (11); "suspicious for urothelial carcinoma" (1); "markedly atypical urothelial cells" (1); "atypical urothelial cells" (1); and "negative for carcinoma" (3). Co-existence of decoy cells and malignant cells were seen in 5/10 cases diagnosed as positive for carcinoma on urine cytology.…”