Open AccessVariability in assessing for BK viremia: whole blood is not reliable and plasma is not above reproach – a retrospective analysis
Author(s) -
Agrawal Neerja,
Echenique Ignacio A.,
Meehan Shane M.,
Limaye Ajit P.,
Cook Linda,
Chang Anthony,
Harland Robert C.,
Javaid Basit,
Kadambi Pradeep V.,
Matushek Scott,
Williams James,
Josephson Michelle A.
Publication year - 2017
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12951
Subject(s) - viremia , biopsy , medicine , polyomavirus infections , bk virus , kidney transplantation , kidney , transplantation , pathology , immunology , gastroenterology , urology , virus
Summary Polyomavirus nephropathy ( PVN ) is a major complication of kidney transplantation. Most reports describe polyomavirus viremia either precedes or is detectable at the time of diagnosis of PVN . This association is the basis of current screening recommendations. We retrospectively reviewed the PCR results of blood and urine samples from 29 kidney transplant recipients with biopsy‐proven PVN . Biopsies were performed for a rise in serum creatinine or persistent high‐level BK viruria. All biopsies showed polyoma virus large T‐antigen expression in tubular epithelium using immunohistochemistry. All had viruria preceding or at the time of biopsy (range, 5.2 × 10 4 to >25 × 10 6 BKV DNA copies/ml). Twenty (69%) had viremia ranging from 2.5 × 10 3 to 4.3 × 10 6 copies/ml at the time of the biopsy. Via blood BK PCR assay, nine (31%) had no BK viremia detected either preceding or at the time of the biopsy. In five recipients where sufficient specimen permitted, additional plasma BK assessment revealed positive detection of viremia. A comparative analysis of assays from two centres was performed with spiked samples. BK DNA may not be detected in the blood of some kidney transplant recipients with histologically confirmed PVN . This may reflect limitation of whole blood as opposed to plasma‐based BK DNA assessment.