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Urine cytology screening for polyoma virus infection following renal transplantation: the Oxford experience
  1. Thomas P Thamboo
  1. National University of Singapore, Singapore
    1. Katie JM Jeffery
    1. Oxford Radcliffe Hospitals, United Kingdom
      1. Peter J Friend
      1. Oxford Radcliffe Hospitals, United Kingdom
        1. Gareth DH Turner
        1. Oxford Radcliffe Hospitals, United Kingdom
          1. Ian SD Roberts (ian.roberts{at}orh.nhs.uk)
          1. Oxford Radcliffe Hospitals, United Kingdom

            Abstract

            Aims: Polyoma virus nephropathy (PVN) has a high incidence of irreversible injury and graft failure. Here we review the first year of a monthly urine cytology screening service, introduced to identify renal transplant patients at risk of 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 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.

            • BK virus
            • Polyoma virus
            • kidney transplantation
            • urine screening

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