Immunologic control for polyomavirus infection after kidney transplantation.
OBJECTIVE
We compared the relative efficacy of urine decoy cell (UDC) and polymerase chain reaction (PCR) to identify polyomavirus (PV) infection, and investigate the efficacy of reduction of immunosuppression for earlier-stage PV infection before irreversible graft injury.


METHODS
A total of 222 de novo renal transplant recipients from March 2003 to September 2005 were enrolled. Prospective UDC monitoring with supplementary PV-PCR was performed. Early reduction of immunosuppression was guided by the results of UDC and PV-PCR.


RESULTS
The positive predictive value of urine cytology for PV infection was 48.8%, and the negative predictive value was 74.1%. After reduction of immunosuppression, negative conversion or significant decrease of viral titer was achieved 100% in 15 PV-PCR positive recipients. Only 3 patients who were neglected or overlooked for PV screening or positive test results early after transplantation were diagnosed as having PV nephropathy, and resulted in graft dysfunction and failure. From January 2001 to December 2002, when we did not monitor the PV infection, there were 7 cases of PV nephropathy among 116 recipients.


CONCLUSIONS
The combination of UDC and PV-PCR should be considered for screening of PV infection. Reduction of immunosuppression based on UDC monitoring and PV viral loads may reduce the incidence of PV nephropathy.
Ahn
Hyung Joon
HJ
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Ju
Man Ki
MK
Jeong
Hyeon Joo
HJ
Kim
Myoung Soo
MS
Kim
Hyon Suk
HS
Huh
Kyu Ha
KH
Lee
Jong Hoon
JH
Kim
Soon Il
SI
Kim
Yu Seun
YS
D017677:Age Distribution; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D016133:Polymerase Chain Reaction; D011120:Polyomavirus / Q000302:isolation & purification*; D027601:Polyomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine; D011183:Postoperative Complications; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D014181:Transplantation Immunology
D007166:Immunosuppressive Agents; D012367:RNA, Viral