title: BK virus infection is associated with hematuria and renal impairment in recipients of allogeneic hematopoetic stem cell transplants.
abstract: BK virus (BKV) is an important pathogen and cause of nephropathy in renal transplant recipients, but its significance following hematopoetic stem cell transplantation (HSCT) is less well described. We measured blood and urine BKV in 124 allogeneic HSCT patients (67 had undergone prior HSCT [surveillance cohort]; 57 were monitored from transplant day 0 [prospective cohort]). BK viruria was manifest in 64.8% of the patients; 16.9% developed viremia. In the prospective cohort, the median time from transplantation to BK viremia development (128 days) was longer than for viruria (24 days; P < .0001). Among clinical factors (sex, disease, transplant type, alemtuzumab use, cytomegalovirus [CMV] viremia, graft-versus-host disease [GVHD], donor HLA C7 allele), only CMV viremia was more common in patients with BKV infection (P < or = .04). There was a direct relationship between blood and urine BKV levels and the occurrence, and degree, of hematuria (P < or = .03). Finally, BKV infection was analyzed along with other clinical factors in relation to the development of post-HSCT renal impairment. On multivariate analysis, only BK viremia (P=.000002) and alternative-donor transplantation (P=.002) were independent predictors of development of post-HSCT renal impairment, with BK viremia associated with a median 1.62mg/dL rise in creatinine from the pretransplant baseline. Among 8 patients in the surveillance cohort with BK viremia, 2 developed biopsy-proven BKV nephropathy requiring hemodialysis. Investigation of whether prophylaxis against, or treatment of, BKV in the post-HSCT setting mitigates the associated morbidities, especially kidney injury, warrants prospective evaluation.
authors: Section of Hematology/Oncology, Department of Medicine, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
authors: Peter H
authors: PH
authors: O'Donnell
authors: Kate
authors: K
authors: Swanson
authors: Michelle A
authors: MA
authors: Josephson
authors: Andrew S
authors: AS
authors: Artz
authors: Sandeep D
authors: SD
authors: Parsad
authors: Charulata
authors: C
authors: Ramaprasad
authors: Kenneth
authors: K
authors: Pursell
authors: Elizabeth
authors: E
authors: Rich
authors: Wendy
authors: W
authors: Stock
authors: Koen
authors: K
authors: van Besien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001739:BK Virus / Q000302:isolation & purification*; D015331:Cohort Studies; D003404:Creatinine / Q000378:metabolism; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006417:Hematuria / Q000097:blood / Q000235:genetics / Q000652:urine / Q000821:virology*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000473:pathology / Q000652:urine / Q000821:virology*; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000097:blood / Q000150:complications* / Q000652:urine / Q000821:virology; D011446:Prospective Studies; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000097:blood / Q000150:complications* / Q000652:urine / Q000821:virology; D055815:Young Adult
chemical_list: D003404:Creatinine