title: Variability in assessing for BK viremia: whole blood is not reliable and plasma is not above reproach - a retrospective analysis.
abstract: Polyomavirus nephropathy (PVN) is a major complication of kidney transplantation. Most reports describe polyomavirus viremia either precedes or is detectable at the time of diagnosis of PVN. This association is the basis of current screening recommendations. We retrospectively reviewed the PCR results of blood and urine samples from 29 kidney transplant recipients with biopsy-proven PVN. Biopsies were performed for a rise in serum creatinine or persistent high-level BK viruria. All biopsies showed polyoma virus large T-antigen expression in tubular epithelium using immunohistochemistry. All had viruria preceding or at the time of biopsy (range, 5.2 × 104to >25 × 106BKV DNA copies/ml). Twenty (69%) had viremia ranging from 2.5 × 103to 4.3 × 106copies/ml at the time of the biopsy. Via blood BK PCR assay, nine (31%) had no BK viremia detected either preceding or at the time of the biopsy. In five recipients where sufficient specimen permitted, additional plasma BK assessment revealed positive detection of viremia. A comparative analysis of assays from two centres was performed with spiked samples. BK DNA may not be detected in the blood of some kidney transplant recipients with histologically confirmed PVN. This may reflect limitation of whole blood as opposed to plasma-based BK DNA assessment.
authors.affiliation: Department of Transplant Nephrology, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Neerja
authors.initials: N
authors.lastname: Agrawal
authors.affiliation: Department of Infectious Disease, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Ignacio A
authors.identifier: http://orcid.org/0000-0002-6301-0121
authors.initials: IA
authors.lastname: Echenique
authors.affiliation: Pacific Rim Pathology, San Diego, CA, USA.
authors.forename: Shane M
authors.initials: SM
authors.lastname: Meehan
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Cook
authors.affiliation: Department of Pathology, University of Chicago, Chicago, IL, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Chang
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Harland
authors.affiliation: MedStar Georgetown Transplant Institute, Georgetown University Hospital, Georgetown, DC, USA.
authors.forename: Basit
authors.initials: B
authors.lastname: Javaid
authors.affiliation: Division of Nephrology, University of Arizona, Tuscon, AZ, USA.
authors.forename: Pradeep V
authors.initials: PV
authors.lastname: Kadambi
authors.affiliation: Department of Clinical Microbiology, University of Chicago, Chicago, IL, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Matushek
authors.affiliation: Cinkate Corporation, Oak Park, IL, USA.
authors.forename: James
authors.initials: J
authors.lastname: Williams
authors.affiliation: Department of Nephrology, University of Chicago, Chicago, IL, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Josephson
mesh_terms: D000952:Antigens, Polyomavirus Transforming / Q000378:metabolism; D001739:BK Virus; D004279:DNA, Viral / Q000097:blood* / Q000235:genetics; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007668:Kidney / Q000821:virology; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000821:virology; D016133:Polymerase Chain Reaction; D027601:Polyomavirus Infections / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D012189:Retrospective Studies; D014412:Tumor Virus Infections / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D014766:Viremia / Q000175:diagnosis* / Q000209:etiology / Q000821:virology
chemical_list: D000952:Antigens, Polyomavirus Transforming; D004279:DNA, Viral
keywords: BK virus; kidney transplant; polyoma; viremia