Predictive Value of the Combination of Peripheral Blood Lymphocyte Count and Urinary Cytology in BK Polyomavirus–associated Nephropathy

Kosuke Masutani, Akihiro Tsuchimoto, Yuta Matsukuma, Shigeru Tanaka, Keizo Kaku, Hiroshi Noguchi, Kei Kurihara, Yasuhiro Okabe, Toshiaki Nakano, Kazuhiko Tsuruya, Hitoshi Nakashima, Masafumi Nakamura, Takanari Kitazono

Research output: Contribution to journalArticle

Abstract

Background: Graft biopsy is the gold standard for diagnosis of BK polyomavirus–associated nephropathy (BKPyVAN), and polymerase chain reaction is the most specific screening technique. Development of a noninvasive, cost-effective marker for BKPyVAN is important. Methods: We reviewed 492 adult kidney transplant patients. We investigated peripheral blood lymphocyte (PBL)count and urinary cytology at graft biopsy in patients with BKVPyAN (n = 21), acute T-cell–mediated rejection (n = 79), and no evidence of acute rejection (n = 149). We performed univariate and multivariate logistic regression and receiver operating characteristics analyses to compare the test performance of PBL count, urinary cytology, and their combination for diagnosis of BKPyVAN. Results: The PBL count at biopsy was significantly lower in the BKPyVAN group than the acute T-cell–mediated rejection and no acute rejection groups (959 ± 290/μL, 1433 ± 673/μL, and 1531 ± 549/μL, respectively; P <.01). The PBL count was 959 ± 290/μL at diagnosis of BKPyVAN and increased to 1123 ± 377/μL, 1238 ± 419/μL, and 1292 ± 491/μL at 1, 2, and 3 months after treatment, respectively (P <.05). On univariate analysis, the area under the curve was significantly higher for the combined model than for PBL and cytology alone (0.930, 0.797, and 0.875, respectively; P <.01). The improved test performance in the combined model remained significant after multivariate adjustment (0.972, 0.844, and 0.928, respectively; P <.01). Conclusions: Decreased PBL count was found in BKPyVAN, and the predictive performance of the combination of PBL count and urinary cytology was significantly enhanced for diagnosis of BKPyVAN.

Original languageEnglish
Pages (from-to)1410-1414
Number of pages5
JournalTransplantation Proceedings
Volume51
Issue number5
DOIs
Publication statusPublished - Jun 2019

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

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