Background. BK virus-associated nephropathy (BKVAN) is one of the most common viral diseases affecting renal allografts. Screening for viral replication may allow for earlier intervention with reduced allograft loss. A plasma viral load >104 copies/mL of BKV DNA is recommended for a presumed diagnosis of BKVAN. Methods. We monitored BKV load on serum and urine samples by Real-Time TaqMan PCR in 229 renal transplant recipients in the first year post-transplantation. Overall, 2025 serum and 2025 urine samples were evaluated. A graft biopsy was performed in 47/229 patients to investigate the declining renal function. Operating characteristics [sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV)] and receiver operating characteristic (ROC) curve analysis at different viral load values were calculated. Results. Serum BKV viral load was >104 in 5/229 patients (2.2%). A histological diagnosis of BKVAN was made in 3/229 patients (1.3%): 3/5 (60.0%) among thosewith serum viral load >104 and 3/4 (75.0%) in those with >1.6 × 104. Operating characteristics of a serum BK load of 104 for the diagnosis of BKVAN were as follows: sensitivity, 100%; specificity, 99.1%; NPV, 100%; PPV, 59.4%. Specificity and PPV rose to 99.6% and 75.0% when using a cut-off level of 1.6 × 104 copies/mL. Conclusions. The recommended level of BK viraemia of 104 copies/mL is useful to identify patients at risk of BKVAN, although specificity and PPV increase by using a cut-off level of 1.6 × 104 copies/mL. BK replication may occur in the first 3 months post-transplantation and subsequently recede. Therefore, the temporal profile of BKV replication has to be accurately evaluated and occasionally elevated values should prompt a closer monitoring.

Monitoring of BK virus replication in the first year following renal transplantation

Costa C.;BERGALLO, Massimiliano;TERLIZZI, Maria Elena;SIDOTI, Francesca;CAVALLO, Rossana
2008

Abstract

Background. BK virus-associated nephropathy (BKVAN) is one of the most common viral diseases affecting renal allografts. Screening for viral replication may allow for earlier intervention with reduced allograft loss. A plasma viral load >104 copies/mL of BKV DNA is recommended for a presumed diagnosis of BKVAN. Methods. We monitored BKV load on serum and urine samples by Real-Time TaqMan PCR in 229 renal transplant recipients in the first year post-transplantation. Overall, 2025 serum and 2025 urine samples were evaluated. A graft biopsy was performed in 47/229 patients to investigate the declining renal function. Operating characteristics [sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV)] and receiver operating characteristic (ROC) curve analysis at different viral load values were calculated. Results. Serum BKV viral load was >104 in 5/229 patients (2.2%). A histological diagnosis of BKVAN was made in 3/229 patients (1.3%): 3/5 (60.0%) among thosewith serum viral load >104 and 3/4 (75.0%) in those with >1.6 × 104. Operating characteristics of a serum BK load of 104 for the diagnosis of BKVAN were as follows: sensitivity, 100%; specificity, 99.1%; NPV, 100%; PPV, 59.4%. Specificity and PPV rose to 99.6% and 75.0% when using a cut-off level of 1.6 × 104 copies/mL. Conclusions. The recommended level of BK viraemia of 104 copies/mL is useful to identify patients at risk of BKVAN, although specificity and PPV increase by using a cut-off level of 1.6 × 104 copies/mL. BK replication may occur in the first 3 months post-transplantation and subsequently recede. Therefore, the temporal profile of BKV replication has to be accurately evaluated and occasionally elevated values should prompt a closer monitoring.
23
10
3333
3336
http://ndt.oxfordjournals.org/content/23/10/3333.long
Costa C.; Bergallo M.; Astegiano S.; Terlizzi M.E.; Sidoti F; Segoloni G.P.; Cavallo R.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/56479
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