The Banff 2009 working proposal for polyomavirus nephropathy: A critical evaluation of its utility as a determinant of clinical outcome

K. Masutani, R. Shapiro, A. Basu, H. Tan, M. Wijkstrom, Parmjeet Randhawa

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Clinical outcome in BK virus nephropathy (BKVN) was examined in relation to clinical and histologic parameters with reference to the BanffWorking Proposal 2009, which emphasizes tubular injury and viral load. Seventy one patients were evaluated in three eras: (i) Era- I: No BKV PCR performed (n = 36), (ii) Era-II: PCR performed for rising creatinine (n = 24) and (iii) Era III: PCR performed for routine screening (n = 11). Six of seventy-one (8.4%) patients were classified as Class A, 46/71 (64.8%) as Class B and 19/71 (26.8%) as Class C. Banff class A never occurred in Era-I. It is a heterogeneous class that includes biopsies with inflammation that have hitherto been included in Class B. Higher inflammation, but not tubular injury, nor histologic viral load correlated with worse creatinine at 3 months. On long-term follow-up, class C associated with graft loss (hazard ratio 2.45, p = 0.03). Clearance of viremia was associated with better graft survival at 5 years (46.0% vs. 25.0%). Viruria clearance was infrequent (15.6%). In conclusion, the clinical utility of the BanffWorking Proposal 2009 derives from scoring of fibrosis and not extent of tubular injury or viral cytopathic effect. The proposal is not superior to existing schemas that include assessment of inflammation, which is a well-known prognostic marker in other renal allograft diseases.

Original languageEnglish
Pages (from-to)907-918
Number of pages12
JournalAmerican Journal of Transplantation
Volume12
Issue number4
DOIs
Publication statusPublished - Apr 1 2012

Fingerprint

Polyomavirus
Inflammation
Viral Load
Polymerase Chain Reaction
Creatinine
Wounds and Injuries
Viral Cytopathogenic Effect
BK Virus
Viremia
Graft Survival
Allografts
Fibrosis
Transplants
Kidney
Biopsy

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

The Banff 2009 working proposal for polyomavirus nephropathy : A critical evaluation of its utility as a determinant of clinical outcome. / Masutani, K.; Shapiro, R.; Basu, A.; Tan, H.; Wijkstrom, M.; Randhawa, Parmjeet.

In: American Journal of Transplantation, Vol. 12, No. 4, 01.04.2012, p. 907-918.

Research output: Contribution to journalArticle

Masutani, K. ; Shapiro, R. ; Basu, A. ; Tan, H. ; Wijkstrom, M. ; Randhawa, Parmjeet. / The Banff 2009 working proposal for polyomavirus nephropathy : A critical evaluation of its utility as a determinant of clinical outcome. In: American Journal of Transplantation. 2012 ; Vol. 12, No. 4. pp. 907-918.
@article{4b38b977b74141a98fdb7e6a983d6ff9,
title = "The Banff 2009 working proposal for polyomavirus nephropathy: A critical evaluation of its utility as a determinant of clinical outcome",
abstract = "Clinical outcome in BK virus nephropathy (BKVN) was examined in relation to clinical and histologic parameters with reference to the BanffWorking Proposal 2009, which emphasizes tubular injury and viral load. Seventy one patients were evaluated in three eras: (i) Era- I: No BKV PCR performed (n = 36), (ii) Era-II: PCR performed for rising creatinine (n = 24) and (iii) Era III: PCR performed for routine screening (n = 11). Six of seventy-one (8.4{\%}) patients were classified as Class A, 46/71 (64.8{\%}) as Class B and 19/71 (26.8{\%}) as Class C. Banff class A never occurred in Era-I. It is a heterogeneous class that includes biopsies with inflammation that have hitherto been included in Class B. Higher inflammation, but not tubular injury, nor histologic viral load correlated with worse creatinine at 3 months. On long-term follow-up, class C associated with graft loss (hazard ratio 2.45, p = 0.03). Clearance of viremia was associated with better graft survival at 5 years (46.0{\%} vs. 25.0{\%}). Viruria clearance was infrequent (15.6{\%}). In conclusion, the clinical utility of the BanffWorking Proposal 2009 derives from scoring of fibrosis and not extent of tubular injury or viral cytopathic effect. The proposal is not superior to existing schemas that include assessment of inflammation, which is a well-known prognostic marker in other renal allograft diseases.",
author = "K. Masutani and R. Shapiro and A. Basu and H. Tan and M. Wijkstrom and Parmjeet Randhawa",
year = "2012",
month = "4",
day = "1",
doi = "10.1111/j.1600-6143.2012.03993.x",
language = "English",
volume = "12",
pages = "907--918",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - The Banff 2009 working proposal for polyomavirus nephropathy

T2 - A critical evaluation of its utility as a determinant of clinical outcome

AU - Masutani, K.

AU - Shapiro, R.

AU - Basu, A.

AU - Tan, H.

AU - Wijkstrom, M.

AU - Randhawa, Parmjeet

PY - 2012/4/1

Y1 - 2012/4/1

N2 - Clinical outcome in BK virus nephropathy (BKVN) was examined in relation to clinical and histologic parameters with reference to the BanffWorking Proposal 2009, which emphasizes tubular injury and viral load. Seventy one patients were evaluated in three eras: (i) Era- I: No BKV PCR performed (n = 36), (ii) Era-II: PCR performed for rising creatinine (n = 24) and (iii) Era III: PCR performed for routine screening (n = 11). Six of seventy-one (8.4%) patients were classified as Class A, 46/71 (64.8%) as Class B and 19/71 (26.8%) as Class C. Banff class A never occurred in Era-I. It is a heterogeneous class that includes biopsies with inflammation that have hitherto been included in Class B. Higher inflammation, but not tubular injury, nor histologic viral load correlated with worse creatinine at 3 months. On long-term follow-up, class C associated with graft loss (hazard ratio 2.45, p = 0.03). Clearance of viremia was associated with better graft survival at 5 years (46.0% vs. 25.0%). Viruria clearance was infrequent (15.6%). In conclusion, the clinical utility of the BanffWorking Proposal 2009 derives from scoring of fibrosis and not extent of tubular injury or viral cytopathic effect. The proposal is not superior to existing schemas that include assessment of inflammation, which is a well-known prognostic marker in other renal allograft diseases.

AB - Clinical outcome in BK virus nephropathy (BKVN) was examined in relation to clinical and histologic parameters with reference to the BanffWorking Proposal 2009, which emphasizes tubular injury and viral load. Seventy one patients were evaluated in three eras: (i) Era- I: No BKV PCR performed (n = 36), (ii) Era-II: PCR performed for rising creatinine (n = 24) and (iii) Era III: PCR performed for routine screening (n = 11). Six of seventy-one (8.4%) patients were classified as Class A, 46/71 (64.8%) as Class B and 19/71 (26.8%) as Class C. Banff class A never occurred in Era-I. It is a heterogeneous class that includes biopsies with inflammation that have hitherto been included in Class B. Higher inflammation, but not tubular injury, nor histologic viral load correlated with worse creatinine at 3 months. On long-term follow-up, class C associated with graft loss (hazard ratio 2.45, p = 0.03). Clearance of viremia was associated with better graft survival at 5 years (46.0% vs. 25.0%). Viruria clearance was infrequent (15.6%). In conclusion, the clinical utility of the BanffWorking Proposal 2009 derives from scoring of fibrosis and not extent of tubular injury or viral cytopathic effect. The proposal is not superior to existing schemas that include assessment of inflammation, which is a well-known prognostic marker in other renal allograft diseases.

UR - http://www.scopus.com/inward/record.url?scp=84859421779&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84859421779&partnerID=8YFLogxK

U2 - 10.1111/j.1600-6143.2012.03993.x

DO - 10.1111/j.1600-6143.2012.03993.x

M3 - Article

C2 - 22390378

AN - SCOPUS:84859421779

VL - 12

SP - 907

EP - 918

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 4

ER -