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Urothelial cell carcinoma after BK polyomavirus infection in kidney transplant recipients: A cohort study of veterans
Author(s) -
Rogers Ralph,
Gohh Reginald,
Noska Amanda
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12752
Subject(s) - medicine , renal cell carcinoma , transplantation , cohort , confidence interval , malignancy , kidney transplantation , nephropathy , cohort study , urology , gastroenterology , surgery , endocrinology , diabetes mellitus
Background BK polyomavirus ( BKP yV) reactivation is a common clinical occurrence in kidney transplant recipients ( KTR ). Several other polyomaviruses have been implicated as pathogens with a direct role in the development of malignancies, raising the question of whether BKP yV might also be oncogenic. Methods This study is the first retrospective, multicenter cohort study evaluating the relative risk for urothelial cell carcinoma ( UCC ) associated with BKP yV infection among KTR , and was conducted among veterans who underwent transplantation between 2000 and 2009. BKP yV cases were defined as those veterans with any clinical evidence of BKP yV infection, including positive polymerase chain reaction testing of urine and/or serum for BKP yV or kidney biopsy showing BKP yV‐associated nephropathy. Results Among the 646 veterans who met inclusion criteria for the study, 103 had clinical evidence of BKP yV infection (16%). The overall relative risk for developing any malignancy after BKP yV infection was 1.13 (95% confidence interval [ CI ] 0.89‐1.44). The adjusted relative risk for malignancy after BKP yV infection was greatest with UCC (8.21, 95% CI 0.75‐89.7) and with metastatic disease of unknown etiology (8.21, 95% CI 0.75‐89.7). The screening prevalence for BKP yV infection increased from 18% for those veterans who underwent transplantation in 2000 to 86% for those veterans who underwent transplantation in 2009, during which time the measured prevalence of BKP yV infection increased from 7% to 24%. Conclusion In this cohort of KTR veterans, no overall increased or decreased relative risk for malignancy was associated with evidence of prior BKP yV infection. A >8‐fold increased risk of developing UCC after BKP yV infection was seen, although this risk was not found to be statistically significant.