title: Prevalence of BK polyomavirus infection and association with renal dysfunction in pediatric heart transplant recipients.
abstract: BACKGROUND
  BK polyomavirus (BKV) infection and nephropathy complicate renal allografts; however, their effect in the native kidneys of pediatric heart transplant (HTx) recipients is unknown. We assessed the prevalence of BKV infection and its association with kidney dysfunction in survivors of pediatric HTx.
  
  
  METHODS
  A single-center retrospective study compared pediatric (aged <18 years ) HTx recipients, with and without BKV (controls), who received an allograft from May 1989 to July 2013. Screening of urine for BKV was performed in patients with chronic kidney disease (CKD) stage ≥2 since 2006, and since April 2012 in all HTx recipients at least at an annual evaluation. Serum for BKV DNA was assayed if BK viruria was present. Data collected included recipient and donor demographics, the immunosuppressive regimen, and history of Epstein-Bar virus (EBV) and cytomegalovirus infection. Statistics included Fisher's exact test, chi-square test, Student's t-test, and multivariate logistic regression.
  
  
  RESULTS
  Of 98 eligible recipients, 83 (85%) were screened: 28 (34%) had BK viruria, and 7 had BK viremia. One viremic patient had biopsy-proven BKV nephropathy that progressed to end-stage renal disease. Risk factors for BK viruria were (1) longer duration since HTx (6.02 vs 2.95 years; p = 0.01), (2) worsening estimated glomerular filtration rate (71.3 vs 86.3 ml/min/1.73 m(2), p = 0.03), (3) history of EBV infection (p = 0.0002), and (4) use of sirolimus (p = 0.0003). After multivariate logistic-regression, only history of EBV infection remained associated with BKV infection (p = 0.015).
  
  
  CONCLUSIONS
  BKV may lead to BK viremia and BK nephropathy in pediatric HTx patients. Routine screening for BK viruria should be considered.
authors.affiliation: Northwestern Feinberg School of Medicine. Electronic address: allison.ducharme-smith@northwestern.edu.
authors.forename: Allison
authors.initials: A
authors.lastname: Ducharme-Smith
authors.affiliation: Departments of b?>Pediatrics.
authors.forename: Ben Z
authors.initials: BZ
authors.lastname: Katz
authors.affiliation: Departments of b?>Pediatrics.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Bobrowski
authors.affiliation: Departments of b?>Pediatrics; Surgery; c?>Siragusa Transplant Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Backer
authors.affiliation: Departments of b?>Pediatrics.
authors.forename: Karen
authors.initials: K
authors.lastname: Rychlik
authors.affiliation: Departments of b?>Pediatrics.
authors.forename: Elfriede
authors.initials: E
authors.lastname: Pahl
mesh_terms: D000293:Adolescent; D001739:BK Virus / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D027601:Polyomavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients; D014412:Tumor Virus Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D019562:Viral Load
chemical_list: D004279:DNA, Viral
keywords: BK viremia; BK viruria; BK virus; BK virus nephropathy; kidney dysfunction; pediatric heart transplant