BK polyomavirus in the urine for follow-up of kidney transplant recipients Article - 2019

Etienne Brochot, Véronique Descamps, Lynda Handala, Justine Faucher, Gabriel Choukroun, Francois Helle, Sandrine Castelain, Catherine François, Gilles Duverlie, Antoine Touzé

Etienne Brochot, Véronique Descamps, Lynda Handala, Justine Faucher, Gabriel Choukroun, Francois Helle, Sandrine Castelain, Catherine François, Gilles Duverlie, Antoine Touzé, « BK polyomavirus in the urine for follow-up of kidney transplant recipients  », Clinical Microbiology and Infection, 2019, 112.e1-112.e5. ISSN 1198-743X

Abstract

OBJECTIVES : After kidney transplantation, human BK polyomavirus (BKPyV) can induce a progressive disease, in three stages : viruria, viremia, and then nephropathy after a few months of viral replication. Therapeutic intervention is recommended when BKPyV is detected in the plasma. The objective of our study was to assess urinary BKPyV nucleic acid test as a predictor for developing viremia. METHODS : We first defined a viruria threshold based on 393 time-matched urine and plasma samples collected after kidney transplantation and then to validate this threshold, we followed-up a cohort of 236 kidney transplant patients. RESULTS : A BKPyV viruria threshold of 6.71 log10 copies/mL best discriminated between plasma-positive and plasma-negative patients (sensitivity : 90.9% (95%CI : 86.5-95) ; specificity : 90.3% (95%CI : 86.3-94.3) ; area under the curve : 0.953 (95%CI : 0.933-0.974). In the validation cohort, the risk of developing BKPyV viremia at one year was 16.5% (39/236) and rose to 90.7% (39/43) if BKPyV viruria remained above the threshold of 6.71 for more than one month. CONCLUSION : Sustained BKPyV viruria is a reliable, early marker of patients at high risk of developing BKPyV viremia. This marker should alert the clinician early, and thus allow timely therapeutic intervention.

Voir la notice complète sur HAL

Actualités