Initiation of a screening protocol for polyoma virus results in a decreased rate of opportunistic non‐BK viral disease after renal transplantation

Koleilat, Issam; Kushnir, Leon; Gallichio, M; Conti, David

doi:10.1111/j.1399-3062.2010.00548.x

Cited by 11 publications

(9 citation statements)

References 32 publications

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“…At our center, we follow a screening regimen described by Koleilat et al [20] screening patients monthly during the first year in an effort to improve early diagnosis [20]. In this study, BK viremia prevalence was 18% [20]. This is consistent with the described incidence of BK viremia in renal transplant recipients (10-20%; [8,23]) Importantly, we choose to intervene at plasma BKV loads of log 3 or greater.…”

Section: Discussionsupporting

confidence: 57%

“…Since 2006, we have utilized a monthly screening policy for all transplant recipients with concomitant 50% reduction in MMF dose with a positive result which we define as log 3 copies/ml (1000 copies/ml) in 2 consecutive blood draws by realtime PCR [19]. Additionally, we found that monthly PCR monitoring for BK viremia, with reduction of immunosuppression resulted in not only improved results, but also decreased rates of cytomegalovirus-(CMV) and Epstein Bar Virus-related (EBV) disease, furthering the idea that BK viremia in addition to its pathologic effects can serve a surrogate marker for excessive immunosuppression [20].…”

Section: Introductionmentioning

confidence: 73%

“…Recommendations include decreasing immunosuppression when serum BK is >10,000 copies/mL [24,25]. At our center, we follow a screening regimen described by Koleilat et al [20] screening patients monthly during the first year in an effort to improve early diagnosis [20]. In this study, BK viremia prevalence was 18% [20].…”

Section: Discussionmentioning

confidence: 99%

“…BK viremia was identified as described previously [20]. Briefly, viral DNA was isolated from 100 mcL of plasma using NucliSens Magnetic Extraction Reagents (bioMerieux, Durham, North Carolina, USA) on an easy Mag extractor (bioMerieux) and eluted to a volume of 50 mcL.…”

Section: Bk Viremia Screeningmentioning

confidence: 99%

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Long-Term Results of a Screening and Immunosuppression Protocol for Polyoma BK Viremia after Renal Transplantation

Schuster¹,

Eldor²,

Leutters³

et al. 2017

Glob Surg

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There is currently no treatment consensus with regards to BK Nephropathy (BKN). Thus, balancing minimization of immunosuppression with the attendant risk of acute rejection remains paramount for long-term allograft survival.Between Jan. 1, 2006 and Dec. 31, 2012, 371 adult renal transplants were performed at our center. Immunosuppression consisted of Thymoglobulin induction followed by maintenance therapy with Tacrolimus, Mycophenolate Mofetil (MMF) and either Sirolimus (88%) or prednisone (12%). Serum PCR screening for BK virus was obtained monthly. BK viremia was detected in 66 (18%) recipients (Group A) while the remaining 305 recipients were never detected to have viremia (Group B). Minimizing immunosuppression for Group A recipients occurred in a stepwise fashion and consisted of an immediate 50% reduction in MMF dosing following by complete discontinuation if viremia did not clear within 3 months. No MMF dosing adjustments were made in Group B patients. All recipients were followed longterm for patient survival and graft function and survival.Group A patient survival at 1, 3, and 5 years was 100%, 98.5%, and 97% compared to 99.3%, 98.4%, and 95.4% in Group B. Graft survival at the same time intervals in Group A was 100%, 98.5%, and 93.9% versus 99%, 97.7%, and 92.5% in Group B recipients. Mean serum creatinine, mg/dl, levels at 1, 3, and 5 years in Group A were 1.6, 1.7 and 1.6 compared to 1.5, 1.5, and 1.6 in Group B. Subsequent to MMF dose reduction/elimination, only on Group A patient progressed to BKN (1.5%) and only 2 patients suffered from an episode of acute rejection (3%).This pre-emptive reduction in immunotherapy at the detection of BK viremia was associated with a low rate of progression to BKN and the development of acute rejection. In addition to comparable long-term function.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Bk Viremia Screeningmentioning

confidence: 99%

See 2 more Smart Citations

Long-Term Results of a Screening and Immunosuppression Protocol for Polyoma BK Viremia after Renal Transplantation

Schuster¹,

Eldor²,

Leutters³

et al. 2017

Glob Surg

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“…This finding was further corroborated by Reischig and colleagues who demonstrated reduction in risk of subsequent BK in the setting of antecedent CMV viremia (HR 0.5, P = .018) . Koleilat et al also found a significantly higher incidence of opportunistic EBV or CMV in a historical cohort without BK as compared to those who developed BK viremia ( P = <.05) . While these studies corroborate the findings of our study, they were not designed to specifically assess the impact of BK viremia on subsequent CMV infection.…”

Section: Discussionmentioning

confidence: 99%

Management of BK viremia is associated with a lower risk of subsequent cytomegalovirus infection in kidney transplant recipients

Jorgenson

Descourouez

Lyu

et al. 2020

Clinical Transplantation

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The risk of subsequent cytomegalovirus infection (CMV) in kidney transplant recipients (KTR) after diagnosis of BK polyomavirus viremia (BKV) is unclear, and current evidence is conflicting. We reviewed all KTR transplanted at our institution between 1/1/2005 and 12/31/2015. Follow‐up began 3 months after transplantation to avoid confounding effects of prophylaxis. Clinically significant BKV, defined as detectable BK viremia >1000 copies/mL via molecular diagnostic testing (PCR), was treated as a time‐varying exposure with 1‐year follow‐up. This viral load cutoff was chosen to ensure a more homogenous population that would be considered to have clinically significant BK viremia that necessitated management via immunosuppressive modification. Patients were then screened for subsequent CMV infection. 2435 RTX recipients met inclusion criteria; of these, 314 developed BKV during follow‐up (BK+). Lymphocyte depletion, tacrolimus maintenance, and biopsy‐proven rejection were significantly higher in the BK+ group. BK+ was associated with lower risk of subsequent CMV infection (BK+ HR 0.45, 95% CI 0.22‐0.94, P = .03, relative risk reduction 55%). When adjusted for significant confounding factors, CMV incidence remained reduced in the BK+ population (HR 0.47, 95% CI 0.22‐0.98, P = .04). This large series of KTR demonstrates that BKV is associated with lower risk of subsequent CMV infection.

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Comparison of three real-time PCR for the quantification of polyomavirus BK

Stellrecht

Espino

Nattanmai

et al. 2013

Journal of Clinical Virology

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Initiation of a screening protocol for polyoma virus results in a decreased rate of opportunistic non‐BK viral disease after renal transplantation

Cited by 11 publications

References 32 publications

Long-Term Results of a Screening and Immunosuppression Protocol for Polyoma BK Viremia after Renal Transplantation

Long-Term Results of a Screening and Immunosuppression Protocol for Polyoma BK Viremia after Renal Transplantation

Management of BK viremia is associated with a lower risk of subsequent cytomegalovirus infection in kidney transplant recipients

Comparison of three real-time PCR for the quantification of polyomavirus BK

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