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Is there a recommended protocol for monitoring for polyomavirus BK viremia in high-risk renal transplant recipients?
Pradip Chakrabarti, MD
Investigators in the field of polyomavirus infection held a Consensus Conference in Basel, Switzerland, in October 2003. Their recommendations will be published in the journal Transplantation later in the year. In essence, routine screening for polyomavirus is indicated every 3-6 months in the first several years following renal transplantation. Testing should also be performed whenever there is graft dysfunction or an allograft biopsy is performed.
The method of screening is left to the discretion of the transplant center. Urine cytology is technically the simplest. The sensitivity is only about 30%, but the specificity approaches 100%. Quantitative polymerase chain reaction (PCR) for viral DNA in the urine is several-fold more sensitive. Viral loads exceeding 1E+07 copies/mL have a > 90% probability of being associated with polyomavirus BK nephropathy. Quantitative PCR in the plasma with loads > 1E+04 or 1E+05 copies/mL have a high specificity for nephropathy, but the sensitivity is only about 50%.
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