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Urine cytology screening for polyoma virus infection following renal transplantation: the Oxford experience
  1. Thomas P Thamboo1,
  2. Katie J M Jeffery2,
  3. Peter J Friend3,
  4. Gareth D H Turner4,
  5. Ian S D Roberts4
  1. 1Department of Pathology, National University of Singapore, National University Hospital, Singapore
  2. 2Department of Microbiology, John Radcliffe Hospital, Oxford, UK
  3. 3Renal Transplant Unit, Churchill Hospital, Oxford, UK
  4. 4Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to:
 Ian S D Roberts
 Department of Cellular Pathology, John Radcliffe Hospital, Oxford OX3 9DU, UK; ian.roberts{at}orh.nhs.uk

Abstract

Objective: To review the first year of a monthly urine cytology screening service, introduced to identify renal transplant patients at risk of polyoma virus nephropathy (PVN), at an early, potentially treatable, stage.

Methods and results: Monthly urine samples (n = 392) were received from 97/108 transplant recipients in 2005. Of 56 patients with follow-up >6 months, 20% and 9% had significant (>10 decoy cells/cytospin) and non-significant positive cytology, respectively. The first positive urine samples occurred most commonly in the second and third month post-transplantation and patients with significantly positive samples had higher 3-month and 6-month serum creatinine levels than patients with negative urine cytology (p<0.01). Four patients with positive urine cytology had a subsequent positive plasma BK virus PCR; 3/97 patients had biopsy-proven PVN, all in the third month, 1–6 weeks after first positive urine samples.

Conclusions: Significant PV viruria is common following renal transplantation with onset usually within the first 3 months. Viruria is associated with worse graft function at 3 and 6 months. The time between urine positivity and clinical PVN is short. More frequent early urine screening would be required to achieve clinical benefit.

  • PVN, polyoma virus nephropathy

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Footnotes

  • Published Online First 8 December 2006

  • Competing interests: None declared.

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