OJOTS  Vol.2 No.4 , November 2012
The Monitoring Interest of BK Virus Load in Renal Allograft Tunisian Recipients: Prospective Study
Abstract: BK virus (BKV) may cause nephropathy in renal transplant recipients receiving immunosuppressive therapy, resulting in renal dysfunction and, possibly graft loss. However, the positive and negative predictive values of BK viral load are still controversial. In this prospective, single-center study, BKV DNA was measured 1, 3 and 6 months after transplantation. The viral load in urine and plasma was quantified with the real-time Q-PCR (Argen kit) in 73 renal allograft recipients Three of them showed acute rejection. To determine the cutoff value of viral load, 60 sera samples of healthy blood donors, matched for age and sex, were tested. The mean plasmatic viral load one month post-transplantation was statistically higher in renal transplant recipients (17.23 copies/ml) compared to that in controls (2 copies/ml) (p: 0.06). This difference of the distribution of viremia values is more evident in the third and sixth month (p: 0.002 and 0.010 respectively). Furthermore, analysis of the kinetic of viral load revealed an average rise of viremia at 3 months (1589.14 copies/ml) followed by its decrease at 6 months (249.75 copies/ml). However, the difference was not statistically significant. The same is true for the distribution of values of viruria and in all cases the average viral load was statistically higher in urine than in plasma. In addition, this study did not shown significant relationsheep between viremia/viruria and the occurrence of acute rejection, the renal function deterioration, the source of allograft or immunosuppressive therapy protocol. If the results of this study demonstrate the importance of the replication of BKV in renal transplant patients from the first month compared to that in immunocompetent subjects, the screening of the DNA of this virus does not appear to have a prognostic value in the occurrence of acute rejection. However, the plasma and urine monitoring of BKV load beyond 6 months , not appear to exclude the relationsheep between these two biomarkers and the occurrence of chronic graft dysfunction.
Cite this paper: Gorgi, Y. , Bacha, M. , Sfar, I. , Mohamed, A. , Aounallah-Skhiri, H. , Dhaouadi, T. , Bardi, R. , Skouri, N. , Abderrahim, E. , Makhlouf, M. , Romdhane, T. , Jendoubi-Ayed, S. , Ayed, K. and Abdallah, T. (2012) The Monitoring Interest of BK Virus Load in Renal Allograft Tunisian Recipients: Prospective Study. Open Journal of Organ Transplant Surgery, 2, 56-61. doi: 10.4236/ojots.2012.24014.

[1]   C. Bressollette-Bodin, M. Coste-Burel, M. Hourmant, V. Sebille, E. Andre-Garnie and B. M. Imbert-Marcille, “A Prospective Longitudinal Study of BK Virus Infection in 104 Renal Transplant Recipients,” American Journal of Transplantation, Vol. 5, No. 8, 2005, pp. 1926-1933. doi:10.1111/j.1600-6143.2005.00934.x

[2]   V. Nickeleit, H. H. Hirsch, M. Zeiler, F. Gudat, O. Prince, G. Thiel and M. J. Mihatsch, “BK-Virus Nephropathy in Renal Transplants-Tubular Necrosis, MHC-Class II Expression and Rejection in a Puzzling Game,” Nephrology Dialysis Transplantation, Vol. 15, No. 3, 2000, pp. 324-332.

[3]   I. Binet, V. Nickeleit, H. H. Hirsch, O. Prince, P. Dalquen, F. Gudat, M. J. Mihatsch and G. Thiel, “Polyomavirus Disease under New Immunosuppressive Drugs: A Cause of Renal Graft Dysfunction and Graft Loss,” Transplantation, Vol. 67, No. 6, 1999, pp. 918-922. doi:10.1097/00007890-199903270-00022

[4]   V. Nickeleit, H. H. Hirsch, F. I. Binet , F. Gudat, O. Prince, P. Dalquen, G. Thiel and M. J. Mihatsch, “Polyomavirus Infection of Renal Allograft Recipients: From Latent Infection to Manifest Disease,”Journal of the American Society of Nephrology. Vol. 10, No. 5, 1999, pp. 1080-1089.

[5]   B. H. de Ligny, I. Etienne, A. Francois, O. Toupance, M. Buchler, G. Touchard, P. Lepogamp, F. Comoz, T. Lob- bedez, M. Godin, J. P. Ryckelynck and Y. Lebranchu, “Polyomavirus-Induced Acute Tubulo-Interstitial Nephritis in Renal Allograft Recipients,” Transplantation Proceedings, Vol. 32, No. 8, 2000, pp. 2760-2761. doi:10.1016/S0041-1345(00)01869-8

[6]   M. Mayr, V. Nickeleit, H. H. Hirsch, M. Dickenmann, M. J. Mihatsch and J. Steiger, “Polyomavirus BK Nephropathy in a Kidney Transplant Recipient: Critical Issues of Diagnosis and Management,”American Journal of Kidney Diseases, Vol. 38, No. 3, 2001, p. E13. doi:10.1053/ajkd.2001.26917

[7]   V. Nickeleit, T. Klimkait, I. F. Binet, P. Dalquen, V. Del Zenero, G. Thiel, M. J. Mihatsch and H. H. Hirsch, “Testing for Polyomavirus Type BK DNA in Plasma to Identify Renal-Allograft Recipients with Viral Nephropathy,” New England Journal of Medicie, Vol. 342, No. 18, 2000, pp. 1309-1315. doi:10.1056/NEJM200005043421802

[8]   R. B. Colvin and S. Mauiyyedi, “Differential Diagnosis between Infection and Rejection in Renal Allografts,” Transplantation Proceedings, Vol. 33, No. 1-2, 2001, pp. 1778-1779.

[9]   C. J. Holman, J. A. van Burik, S. H. Hinrichs Jr. and H. H. Balfour Jr., “Specific Detection of Human BK Poly- omavirus in Urine Samples of Immunocompromised Patients,” Clinical and Diagnostic Laboratory Immunology, Vol. 10, No. 1, 2003, pp. 66-69.

[10]   P. Randhawa, A. Ho, R. Shapiro, A. Vats, P. Swalsky, S. Finkelstein, J. Uhrmacher and K. Weck, “Correlates of Quantitative Measurement of BK Polyomavirus (BKV) DNA with Clinical Course of BKV Infection in Renal Transplant Patients,” Journal of Clinical Microbiology, Vol. 42, No. 3, 2004, pp. 1176-1180. doi:10.1128/JCM.42.3.1176-1180.2004

[11]   D. Cimbaluk, L. Pitelka, L. Kluskens and P. Gattuso, “Update on Human Polyomavirus BK Nephropathy,” Diagnostic Cytopathology, Vol. 37, No. 10, 2009, pp. 773-779. doi:10.1002/dc.21147

[12]   H. H. Hirsch, D. C. Brennan, C. B. Drachenberg, F. Ginevri, J. Gordon, A. P. Limaye, M. J. Mihatsch, V. Nickeleit, E. Ramos, P. Randhawa, R. Shapiro, J. Steiger, M. Suthanthiran and J. Trofe, “Polyomavirus-Associated Nephropathy in Renal Transplantation: Interdisciplinary Analyses and Recommendations,” Transplantation, Vol. 79, No. 10, 2005, pp. 1277-1286.

[13]   M. S. Sachdeva, R. Nada, V. Jha, V. Sakhuja and K. Joshi, “The High Incidence of BK Polyoma Virus Infection among Renal Transplant Recipients in India,” Transplantaion, Vol. 77, No. 3, 2004, pp. 429-431. doi:10.1097/01.TP.0000113163.02039.30

[14]   A. Egli, S,. K?hli, M. Dickenmann and H. H. Hirsch, “Inhibition of Polyomavirus BK-Specific T-Cell Responses by Immunosuppressive Drugs,” Transplantation, Vol. 88, No. 10, 2009, pp. 1161-1168. doi:10.1097/TP.0b013e3181bca422

[15]   H. H. Hirsch and J. Steiger, “Polyomavirus BK,” The Lancet Infectious Diseases, Vol. 3, No. 10, 2003, pp. 611-623. doi:10.1016/S1473-3099(03)00770-9

[16]   A. Y. Leung, M. Chan, S. C. Tang, R. Liang and Y. L. Kwong, “Real-Time Quantitative Analysis of Polyoma BK Viremia and Viruria in Renal Allograft Recipients,”Journal of Virological Methods, Vol. 103, No. 1, 2002, pp. 51-56.

[17]   C. Merlino, M. Bergallo, F. Giacchino, R. Daniele, C. Bollero, L. Comune, G. P. Segoloni and R. Cavallo, “Human Polyoma-Virus BK Monitoring by Quantitative PCR in Renal Transplant Recipients,” Intervirology, Vol. 47, No. 1, 2004, pp. 41-47. doi:10.1159/000076641

[18]   A. Dolei, V. Pietropaolo, E. Gomes, C. Di Taranto, M. Ziccheddu, M. A. Spanu, C. Lavorino, M. Manca and A. M. Degener, “Polyomavirus Persistance in Lymphocytes: Prevalence in Lymphocytes from Blood Donors and Healthy Personnel of a Blood Transfusion Centre,” Journal of General Virology, Vol. 81, No. 8, 2000, pp. 1967-1973.

[19]   C. B. Drachenberg, H. H. Hirsch, E. Ramos and J. C. Papadimitriou, “Polyomavirus Disease in Renal Trans- plantation, Review of Pathological Findings and Diagnostic Methods,” Human Pathology, Vol. 36, No. 12, 2005, pp. 1245-1255. doi:10.1016/j.humpath.2005.08.009

[20]   H. H. Hirsch, W. Knowles, M. Dickenmann, J. Passweg, T. Klimkait, M. J. Mihatsch and J. Steiger, “Prospective Study of Polyomavirus Type BK Replication and Nephropathy in Renal-Transplan Recipients,” New England Journal of Medicine, Vol. 347, No. 7, 2002, pp. 488-496. doi:10.1056/NEJMoa020439

[21]   Y. M. Barri, I. Ahmad, B. L. Ketel, G. W. Barone, P. D. Walker, S. M. Bonsib and S. R. Abul-Ezz, “Polyoma Viral Infection in Renal Transplantation: The Role of Immunosuppressive Therapy,” Clinical Transplantation, Vol. 15, No. 4, 2001, pp. 240-246.

[22]   E. Ramos, C. B. Drachenberg, J. C. Papadimitriou, O. Hamze, J. C. Fink, D. K. Klassen, R. C. Drachenberg, A. Wiland, R. Wali, C. B. Cangro, E. Schweitzer, S. T. Bartlett and M. R. Weir, “Clinical Course Of Polyoma Virus Nephropathy in 67 Renal Transplant Patients,” Journal of the American Society of Nephrology, Vol. 13, No. 8, 2002, pp. 2145-2151. doi:10.1097/01.ASN.0000023435.07320.81

[23]   A. Sessa, A. Esposito, A. Giliberti, M. Bergallo, C. Costa, R. Rossano, E. Lettieri and M. Capuano, “BKV Reactivation in Renal Transplant Recipients: Diagnostic and Therapeutic Strategy-Case Reports,” Transplantation Proceedings, Vol. 40, No. 6, 2008, pp. 2055-2058. doi:10.1016/j.transproceed.2008.05.007