PMID- 37598855
OWN - NLM
STAT- Publisher
LR  - 20231020
IS  - 1523-1755 (Electronic)
IS  - 0085-2538 (Linking)
VI  - 104
IP  - 5
DP  - 2023 Nov
TI  - An observational cohort study of histological screening for BK polyomavirus 
      nephropathy following viral replication in plasma.
PG  - 1018-1034
LID - S0085-2538(23)00563-X [pii]
LID - 10.1016/j.kint.2023.07.025 [doi]
AB  - Systematic screening for BKPyV-DNAemia has been advocated to aid prevention and 
      treatment of polyomavirus associated nephropathy (PyVAN), an important cause of 
      kidney graft failure. The added value of performing a biopsy at time of 
      BKPyV-DNAemia, to distinguish presumptive PyVAN (negative SV40 
      immunohistochemistry) and proven PyVAN (positive SV40) has not been established. 
      Therefore, we studied an unselected cohort of 950 transplantations, performed 
      between 2008-2017. BKPyV-DNAemia was detected in 250 (26.3%) transplant 
      recipients, and positive SV40 in 91 cases (9.6%). Among 209 patients with a 
      concurrent biopsy at time of first BKPyV-DNAemia, 60 (28.7%) biopsies were SV40 
      positive. Plasma viral load showed high diagnostic value for concurrent SV40 
      positivity (ROC-AUC 0.950, 95% confidence interval 0.916-0.978) and the 
      semiquantitatively scored percentage of tubules with evidence of polyomavirus 
      replication (pvl score) (0.979, 0.968-0.988). SV40 positivity was highly unlikely 
      when plasma viral load is below 4 log(10) copies/ml (negative predictive value 
      0.989, 0.979-0.994). In SV40 positive patients, higher plasma BKPyV-DNA load and 
      higher pvl scores were associated with slower viral clearance from the blood 
      (hazard ratio 0.712, 95% confidence interval 0.604-0.839, and 0.327, 0.161-0.668, 
      respectively), whereas the dichotomy positivity/negativity of SV40 
      immunohistochemistry did not predict viral clearance. Although the pvl score 
      offers some prognostic value for viral clearance on top of plasma viral load, the 
      latter provided good guidance for when a biopsy was unnecessary to exclude PyVAN. 
      Thus, the distinction between presumptive and proven PyVAN, based on SV40 
      immunohistochemistry, has limited clinical value. Hence, management of 
      BKPyV-DNAemia and immunosuppression reduction should be weighed against the risk 
      of occurrence of rejection, or exacerbation of rejection observed concomitantly.
CI  - Copyright (c) 2023 International Society of Nephrology. Published by Elsevier Inc. 
      All rights reserved.
FAU - Cleenders, Evert
AU  - Cleenders E
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of Public 
      Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics 
      Centre, KU Leuven, Leuven, Belgium.
FAU - Koshy, Priyanka
AU  - Koshy P
AD  - Department of Imaging and Pathology, University Hospitals Leuven, Leuven, 
      Belgium.
FAU - Van Loon, Elisabet
AU  - Van Loon E
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of 
      Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, 
      Belgium.
FAU - Lagrou, Katrien
AU  - Lagrou K
AD  - Department of Microbiology, Immunology and Transplantation, Laboratory of 
      Clinical Microbiology, KU Leuven, Leuven, Belgium.
FAU - Beuselinck, Kurt
AU  - Beuselinck K
AD  - Department of Microbiology, Immunology and Transplantation, Laboratory of 
      Clinical Microbiology, KU Leuven, Leuven, Belgium; Department of Laboratory 
      Medicine, University Hospitals Leuven, Leuven, Belgium.
FAU - Andrei, Graciela
AU  - Andrei G
AD  - Department of Microbiology, Immunology and Transplantation, Rega Institute, 
      Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium.
FAU - Crespo, Marta
AU  - Crespo M
AD  - Department of Nephrology, Hospital del Mar Medical Research Institute (IMIM), 
      Hospital del Mar, Barcelona, Spain.
FAU - De Vusser, Katrien
AU  - De Vusser K
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of 
      Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, 
      Belgium.
FAU - Kuypers, Dirk
AU  - Kuypers D
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of 
      Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, 
      Belgium.
FAU - Lerut, Evelyne
AU  - Lerut E
AD  - Department of Imaging and Pathology, University Hospitals Leuven, Leuven, 
      Belgium.
FAU - Mertens, Kris
AU  - Mertens K
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium.
FAU - Mineeva-Sangwo, Olga
AU  - Mineeva-Sangwo O
AD  - Department of Microbiology, Immunology and Transplantation, Rega Institute, 
      Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium.
FAU - Randhawa, Parmjeet
AU  - Randhawa P
AD  - Division of Transplantation Pathology, the Thomas E. Starzl Transplantation 
      Institute, University of Pittsburgh Medical Center-Montefiore Hospital, 
      University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
FAU - Senev, Aleksandar
AU  - Senev A
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium; Histocompatibility 
      and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium.
FAU - Snoeck, Robert
AU  - Snoeck R
AD  - Department of Microbiology, Immunology and Transplantation, Rega Institute, 
      Laboratory of Virology and Chemotherapy, KU Leuven, Leuven, Belgium.
FAU - Sprangers, Ben
AU  - Sprangers B
AD  - Department of Nephrology and Renal Transplantation, University Hospitals Leuven, 
      Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Rega 
      Institute, Laboratory of Molecular Immunology, KU Leuven, Leuven, Belgium.
FAU - Tinel, Claire
AU  - Tinel C
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium.
FAU - Van Craenenbroeck, Amaryllis
AU  - Van Craenenbroeck A
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of 
      Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, 
      Belgium.
FAU - van den Brand, Jan
AU  - van den Brand J
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium.
FAU - Van Ranst, Marc
AU  - Van Ranst M
AD  - Department of Microbiology, Immunology and Transplantation, Rega Institute, 
      Laboratory of Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium.
FAU - Verbeke, Geert
AU  - Verbeke G
AD  - Department of Public Health and Primary Care, Leuven Biostatistics and 
      Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium.
FAU - Coemans, Maarten
AU  - Coemans M
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of Public 
      Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics 
      Centre, KU Leuven, Leuven, Belgium.
FAU - Naesens, Maarten
AU  - Naesens M
AD  - Department of Microbiology, Immunology and Transplantation, Nephrology and Renal 
      Transplantation Research Group, KU Leuven, Leuven, Belgium; Department of 
      Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, 
      Belgium. Electronic address: maarten.naesens@kuleuven.be.
LA  - eng
PT  - Journal Article
DEP - 20230819
PL  - United States
TA  - Kidney Int
JT  - Kidney international
JID - 0323470
SB  - IM
OTO - NOTNLM
OT  - biopsy
OT  - kidney transplantation
OT  - polyomavirus nephropathy
OT  - screening
EDAT- 2023/08/21 00:41
MHDA- 2023/08/21 00:41
CRDT- 2023/08/20 19:25
PHST- 2022/08/29 00:00 [received]
PHST- 2023/07/10 00:00 [revised]
PHST- 2023/07/28 00:00 [accepted]
PHST- 2023/08/21 00:41 [pubmed]
PHST- 2023/08/21 00:41 [medline]
PHST- 2023/08/20 19:25 [entrez]
AID - S0085-2538(23)00563-X [pii]
AID - 10.1016/j.kint.2023.07.025 [doi]
PST - ppublish
SO  - Kidney Int. 2023 Nov;104(5):1018-1034. doi: 10.1016/j.kint.2023.07.025. Epub 2023 
      Aug 19.