JC Virus Infection in Renal Transplant Patients: Correlation with Urine Cytology, Molecular (PCR) Analysis and Clinical Findings
Daniel Smith, Cary Chisholm, Renu Khode, Kimberly Walker, Jaeson Gildon, Lubna Sayage-Rabie, Arundhati Rao. Scott and White Hospital, Temple, TX
Background: Polyomavirus (BK and JC viruses) which are usually latent in the urothelium and renal epithelium can cause infections in immunosuppressed patients as also graft dysfunctions. Primary infection usually occurs at a young age and remains as a latent infection in greater than 90% of the adult population. Viral reactivation can be seen in immunocompromised individuals and can be detected by cytology as “decoy cells”, immunohistochemistry, or by molecular methods. Reactivation of BKV in renal transplant recipients can result in BKV nephropathy and cause or simulate graft rejection. While much is known about BKV in renal transplant recipients, very few studies have examined the clinical implication of chronic infection with JCV in this population. The goals of this study are to determine the rate of JCV infection in renal transplant recipients, determine the sensitivity and specificity of decoy cells with respect to molecular assay, and to identify clinical and laboratory manifestations associated with JCV infection.
Design: Over a four month period, urines submitted for BKV/JCV PCR from patients status post renal transplant were included. Specimens were assayed by PCR and cytology. For molecular testing, DNA was extracted from urine using Biomerieux EasyMag and assayed using FOCUS Diagnostics BK and JC virus assays. For cytologic studies, Thinprep slides were prepared from urine specimens which were positive for JCV along with 36 that were negative.
Results: Over a four month period, the urines of 281 renal transplant patients were submitted for BKV/JCV molecular testing. 101 were positive for BKV, 20 JCV, and 7 for BKV and JCV. Median time to JC infection following transplant was 64 days. JC viral load ranged from 3.6 log (10) to greater than 7 log (10) copies/ml. The mean BUN and creatinine was 1.42 mg/dl and 23 mg/dl, respectively. Acute rejection was not observed in any patients infected with JCV. The sensitivity and specificity of decoy cells in diagnosing JCV is 30% and 97%, respectively, with positive and negative predictive values of 86% and 71%, respectively. The presence of decoy cells was not related to viral load or viral co-infection.
Conclusions: Urine cytology and decoy cell identification may not represent an optimal screening tool for JCV infection and the presence of decoy cells does not correlate with viral load or BKV co-infection. The incidence of JCV infection in renal transplant patients is low compared to that of BKV. Unlike BKV in this patient population, JCV is not associated with specific acute clinical or laboratory finding.
Category: Kidney (does not include tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 284, Wednesday Afternoon