title: Co-infection of polyomavirus-BK and cytomegalovirus in renal transplant recipients.
abstract: BACKGROUND
  Polyomavirus-BK (BK) is a significant cause of allograft dysfunction in renal transplant recipients. Cytomegalovirus (CMV) and BK infection are thought to be possible risk factors for one another, but no supporting data are yet available.
  
  
  METHODS
  The authors monitored BK and CMV infection by quantitative polymerase chain reaction (PCR) in 69 renal transplant recipients with serum creatinine elevation to determine the prevalence of co-infection. In addition, 150 adult renal transplant recipients were also retrospectively analyzed for both infections.
  
  
  RESULTS
  Of 69 recipients, 12 were plasma BK-PCR-positive. Eight of the 12 showed high BK levels (>10 copies) and BK nephropathy. Six of the 12 were also CMV-PCR-positive compared with only 3 of 57 plasma BK-negative patients (50% vs. 5.3%, P=0.001). Comparatively, the incidence of Epstein-Barr virus infection was similar in both groups (1 of 12 [8.3%] vs. 2 of 57 [3.5%], P =not significant). In addition, retrospective analysis of CMV-PCR-positivity in 150 adult renal transplant recipients showed similar results (5 of 6 in BK-PCR-positive [83%] vs. 8 of 144 in BK-PCR-negative [5.6%], P=0.00001). More plasma BK-PCR-positive patients had concomitant CMV infection than CMV-PCR-positive patients with BK infection (5 of 6 [83%] vs. 4 of 13 [31%], P=0.05).
  
  
  CONCLUSIONS
  In conclusion, high plasma BK-positivity (>10) is significantly associated with BK nephropathy. Plasma BK-positivity is highly associated with co-infection of CMV, suggesting possible risk factors for one another. Therefore, detection of either infection strongly suggests the need to monitor for the other. This strategy may lead to the prevention of virus-induced complications by preemptive antiviral therapy in renal allografts.
authors.affiliation: Transplant Immunology Laboratory, Ahmanson Pediatric Center, Steven Spielberg Pediatric Research Laboratories, Cedars-Sinai Medical Center/University of California, Los Angeles, 90048, USA. mieko.toyoda@cshs.org
authors.forename: Mieko
authors.initials: M
authors.lastname: Toyoda
authors.forename: Dechu P
authors.initials: DP
authors.lastname: Puliyanda
authors.forename: Nurmamet
authors.initials: N
authors.lastname: Amet
authors.forename: Lara
authors.initials: L
authors.lastname: Baden
authors.forename: Vinh
authors.initials: V
authors.lastname: Cam
authors.forename: Raju
authors.initials: R
authors.lastname: Radha
authors.forename: Andy
authors.initials: A
authors.lastname: Pao
authors.forename: Ashley
authors.initials: A
authors.lastname: Vo
authors.forename: Suphamai
authors.initials: S
authors.lastname: Bunnapradist
authors.forename: Asha
authors.initials: A
authors.lastname: Moudgil
authors.forename: Stanley C
authors.initials: SC
authors.lastname: Jordan
mesh_terms: D000293:Adolescent; D000328:Adult; D001739:BK Virus / Q000235:genetics / Q000302:isolation & purification; D002648:Child; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications*; D004279:DNA, Viral / Q000097:blood / Q000302:isolation & purification / Q000652:urine; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011120:Polyomavirus / Q000235:genetics / Q000302:isolation & purification; D027601:Polyomavirus Infections / Q000150:complications* / Q000453:epidemiology; D011183:Postoperative Complications / Q000821:virology*
chemical_list: D004279:DNA, Viral