Early identification of renal transplant recipients with high risk of polyomavirus-associated nephropathy.
Polyomavirus BK (BKPyV) is ubiquitous among humans. Following primary infection, the virus remains latent predominantly in the hosts' uroepithelial cells. Up to 10 % of renal transplant recipients show a viral reactivation that can lead to polyomavirus-associated nephropathy (PyVAN). In the absence of early treatments, the risk of graft loss is up to 80 %. Monitoring viral load in urine and plasma by real-time PCR after transplantation is the most common diagnostic tool to detect viral reactivation. In the present retrospective study, BKPyV-DNA loads in urine and plasma by quantitative real-time PCR were associated with clinical data, including HLA haplotype, blood parameters and viral genotype, of 40 renal transplant recipients at the University Clinics of Cologne. Seventeen out of 329 patients screened for BKPyV from January 2009 to October 2013 were detected BKPyV positive in urine only, whereas in 23 patients the virus became additionally detectable in plasma. Among these, ten patients progressed to PyVAN. Overall, the present study showed that the detection from the third month onwards after transplantation of a first viruric episode with a median viral load of 1 × 10(8) copies/mL, followed after few days by a first viremic episode with a median viral load of >1 × 10(4) copies/mL, was strongly associated with the development of PyVAN. In conclusion, the viral load and the temporal profile of the first viruric and viremic episode post-transplantation, in combination with specific features of the host immune response, should be considered as relevant clinical determinants of the risk of renal transplant recipients to progress to PyVAN.
Institute of Virology, University of Cologne, Cologne, Germany.
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K
Teutsch
Institute of Virology, University of Cologne, Cologne, Germany.
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F
Schweitzer
Institute of Virology, University of Cologne, Cologne, Germany.
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E
Knops
Institute of Virology, University of Cologne, Cologne, Germany.
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R
Kaiser
Institute of Virology, University of Cologne, Cologne, Germany.|National Reference Center for Papillomaviruses and Polyomaviruses, University of Cologne, Cologne, Germany.
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H
Pfister
Institute of Virology, University Hospital Essen, Essen, Germany.
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J
Verheyen
Department of Pathology, University of Cologne, Cologne, Germany.
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H
Göbel
Renal Division, Department of Medicine, Transplant Center Cologne, University of Cologne, Cologne, Germany.
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T
Cingöz
Institute of Virology, University of Cologne, Cologne, Germany. veronica.di-cristanziano@uk-koeln.de.
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Di Cristanziano
D000328:Adult; D000368:Aged; D000483:Alleles; D005260:Female; D015234:HLA-A Antigens / Q000235:genetics / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D011120:Polyomavirus / Q000145:classification / Q000235:genetics; D027601:Polyomavirus Infections / Q000150:complications* / Q000821:virology; D011379:Prognosis; D012307:Risk Factors; D066027:Transplant Recipients; D019562:Viral Load; D014779:Virus Replication; D055815:Young Adult
D015234:HLA-A Antigens
BKPyV; Nephropathy; PyVAN; Renal transplant recipient