Diagnostic utility of urine cytology in early detection of polyomavirus in transplant patients

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• 作者：Juan Xing ; MD^a ; Gary W. Procop ; MD^b ; Jordan P. Reynolds ; MD^a ; Andres Chiesa-Vottero ; MD^a ; Yaxia Zhang ; MD ; PhD^a ; ^{Zhangy7@ccf.org}
• 关键词：BK polyomavirus (BKV) ; JC polyomavirus (JCV) ; Polyomavirus-associated nephropathy (PVAN) ; Urine cytology (UC) ; Real-time quantitative BK virus polymerase chain reaction test (Qt-BK PCR)
• 刊名：Journal of the American Society of Cytopathology
• 出版年：2017
• 出版时间：January-February 2017
• 年：2017
• 卷：6
• 期：1
• 页码：28-32
• 全文大小：561 K
• 卷排序：6

文摘

Polyomavirus-associated nephropathy (PVAN) is one of the most common disease affecting transplant patients, mainly caused by BK polyomavirus (BKV) and with <5% of the cases caused by JC polyomavirus (JCV). Screening and early intervention, including appropriate reduction in immunosuppressive therapy, are critical to reduce allograft loss. The presence of decoy cells in the urine is a characteristic cytopathic effect of polyomavirus. The goal of this study was to investigate the significance of decoy cells in urine cytology in transplant patients, comparing with the plasma viral replication level detected by the real-time quantitative BK virus polymerase chain reaction test (Qt-BK PCR).MethodsA cohort of post-transplantation patients with serum BKV level monitored by Qt-BK PCR from 2008 to 2013 was studied. Among them, 35 patients had both urine cytology (UC) analysis and Qt-BK PCR performed. The clinical presentation along with the available UC slides were retrieved and reviewed.ResultsCompared with Qt-BK PCR, the sensitivity, specificity, positive predictive value, and negative predictive value of urine cytology analyzed within one week apart were 92%, 71%, 85%, and 83%, respectively. The accuracy of the UC was 84%. More interestingly, UC played a key role in identifying a case of JCV associated PVAN whereas Qt-BK PCR from both urine and plasma failed to detect this virus.ConclusionOur data suggests that urine cytology is a sensitive surveillance test for early detection of polyomavirus in transplant patients, and it is particularly useful to screen for rare JC polyomavirus.