BK viral infection in an Australian pediatric renal transplant population

Abstract

BK virus (BKV) is recognized as a significant cause of renal allograft dysfunction in adults, and there is growing awareness of its importance in the pediatric population. Eighteen pediatric renal transplant recipients and 18 age-matched controls were prospectively studied. Anti-BKV immunoglobulin G (IgG) and IgM titres were assayed in all subjects at entry to the study. Polymerase chain reaction (PCR) for BKV DNA was performed on urine and serum at entry, and prospectively tested again at 4, 8 and 12 months. Mean age +/- s.d. of transplant recipients and controls was 14.6 +/- 3.3 and 13.9 +/- 0.33 yr respectively [not significant (NS)]. Transplant patients were studied at a mean time of 5.6 +/- 4.2 yr post-transplant. 56% of transplant patients and 39% of controls were seropositive (+ve BKV IgG) (NS). Plasma BKV PCR was positive in one transplant patient (who also had positive urine PCR) and in none of the controls. The prevalence of positive urine PCR in transplant patients was greater than in controls (33% vs. 0%, p = 0.02). Positive urine BKV PCR was more commonly found in patients treated with mycophenolate than azathioprine (p = 0.04). We conclude that the prevalence of BKV seropositivity and viral activation in this Australian pediatric renal transplant population is similar to that reported in adult and pediatric populations in other countries. BK viruria was more common in children with greater immunosuppression, suggesting that this group is at higher risk of BKV induced nephropathy.

BKV-infection in kidney graft dysfunction

“…Besides these high frequencies of BKV infection signals, 5,21,[23][24][25][26] this study also confi rms the previous evidence of no clinical or histopathological characteristics associated with BKV infection. 2,24,26,27,28 In agreement with others, [26][27][28] there was no association with acute rejection or with its treatment. On the other hand, reinforcing the importance of an early diagnosis, no case of viremia among patients with current CAN highlights their probable severe renal damage hindering the viral replication.…”

“…16,24,44,45 Finally, viremia is a late BKV-infection event, associated with graft dysfunction and works as a marker for BKN development. 28 It occurs 16 to 33 weeks previously to the establishment of BKN, 13 and invariably appears later than viruria. 36 Thus, an intense BKV-viruria predicts viremia, and probably BKN.…”

“…36 Despite the controversy, the uncommon occurrence of viruria or viremia among health people are due to JCV, a less uropathogenic agent. 24,28,35,[37][38][39][40][41] Hence, BKV viruria itself probably have clinical relevance.…”

Prospective Monitoring of Polyomavirus BK Replication and Impact of Pre-Emptive Intervention in Pediatric Kidney Recipients

“…The studies reported to date are retrospective, or evaluate limited prospective sampling (13,(15)(16)(17). In our prospective study, the prevalence of BK viruria and viremia are 63% and 21%, respectively.…”

Nefropatía asociada a poliomavirus BK en trasplante renal

“…Reportes americanos de centros de trasplante renal confirman sostenido incremento del porcentaje de su prevalencia (5% a 10%) (1,2) . Emerge como una patología que puede ocasionar la pérdida del injerto en más de la mitad de los casos (3)(4)(5)(6)(7)(8) .…”