title: Clinical usefulness of BK virus plasma quantitative PCR to prevent BK virus associated nephropathy.
abstract: The present study investigated the clinical usefulness of plasma real-time polymerase chain reaction (PCR) (plasma-PCR) in the prevention of BK virus-associated nephropathy (BKVAN). First, we investigated the diagnostic value of plasma BK-PCR, urine BK-PCR, and urine cytology for the prediction of BKVAN retrospectively. Then we designed a prospective study of regular plasma-PCR monitoring and pre-emptive immunosuppression (IS) reduction based on the result. In the retrospective cohort, the prevalence of BKVAN was 3.7% (14/379) and the positive rate of decoy cells, urine-PCR (>1 × 10(10) copies/ml), and plasma-PCR (>1 × 10(4) copies/ml) was 18.6%, 11.1%, and 5.5%, respectively. Plasma-PCR was superior to urine-PCR or urine cytology in specificity and positive predictive value for detection of BKVAN. In prospective study, regular monitoring of plasma-PCR detected significant BKV viremia in 8.3% (12/145) and BKVAN in 1 patient (0.6%). After IS reduction, BKV viremia was eliminated in 91.6% (11/12) within 103 days (25-254). In patients with viremia, the frequency of acute rejection did not increase and allograft function did not differ significantly compared with those in patients without viremia during the first year post-transplant (P > 0.05, in both). Plasma-PCR is useful to predict an increased risk for BKVAN, and regular monitoring is effective to prevent the development of BKVAN.
authors.affiliation: Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Yu Ah
authors.initials: YA
authors.lastname: Hong
authors.forename: Hyun Gyung
authors.initials: HG
authors.lastname: Kim
authors.forename: In O
authors.initials: IO
authors.lastname: Sun
authors.forename: Sun Ryoung
authors.initials: SR
authors.lastname: Choi
authors.forename: Hoon Suk
authors.initials: HS
authors.lastname: Park
authors.forename: Sung Hak
authors.initials: SH
authors.lastname: Lee
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
authors.forename: Cheol Whee
authors.initials: CW
authors.lastname: Park
authors.forename: Yeong Jin
authors.initials: YJ
authors.lastname: Choi
authors.forename: Yong-Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000328:Adult; D001739:BK Virus / Q000235:genetics / Q000302:isolation & purification*; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000032:analysis; D018450:Disease Progression; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000821:virology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000150:complications* / Q000175:diagnosis; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction / Q000191:economics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000150:complications* / Q000175:diagnosis; D019562:Viral Load; D014766:Viremia / Q000150:complications / Q000175:diagnosis
chemical_list: D004279:DNA, Viral; D007166:Immunosuppressive Agents