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World J Gastroenterol. Jan 28, 2016; 22(4): 1532-1540
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1532
Different behaviour of BK-virus infection in liver transplant recipients
Ilaria Umbro, Francesca Tinti, Paolo Muiesan, Anna Paola Mitterhofer
Ilaria Umbro, Francesca Tinti, Paolo Muiesan, The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom
Ilaria Umbro, Francesca Tinti, Anna Paola Mitterhofer, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, 00185 Rome, Italy
Author contributions: Umbro I wrote the paper; Tinti F performed the literature search; Muiesan P and Mitterhofer AP designed the research.
Supported by Italian Society of Nephrology.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anna Paola Mitterhofer, MD, PhD, FEBTM, Associate Professor, Department of Clinical Medicine, Nephrology and Dialysis B, Sapienza University of Rome, Viale dell’Università 37, 00185 Rome, Italy. annapaola.mitter@uniroma1.it
Telephone: +39-6-49972089 Fax: +39-6-49972089
Received: May 29, 2015
Peer-review started: June 2, 2015
First decision: September 11, 2015
Revised: October 10, 2015
Accepted: November 24, 2015
Article in press: November 24, 2015
Published online: January 28, 2016
Processing time: 236 Days and 16.6 Hours
Abstract

Polyomavirus BK (BKV) infects up to 90% of the general population. After primary infection, occurring early during childhood, a state of non-replicative infection is established in the reno-urinary tract, without complications for immunocompetent hosts. In immunocompromised individuals, particularly transplanted patients, asymptomatic BKV viremia and/or viruria can be observed. Renal grafts may also be sources of infection as BKV prefers kidneys rather than other solid organs for transplantation such as the liver. The mechanism behind the higher incidence of BKV infection in kidney transplant patients, compared to liver or heart transplantation, is unclear and the prevalence of BKV infection in non-renal solid organ transplants has not been yet thoroughly investigated. We evaluated the prevalence of Polyomavirus BK infection among liver transplant recipients. A PubMed search was conducted using the terms BKV infection AND liver transplant recipients; BKV AND non-renal solid organ transplant*; BKV infection AND immunosuppression; the search was limited to title/abstract and English-language articles published from 2000, to March 2015. Eleven relevant studies suggest that the prevalence of BKV viruria and/or viremia among liver transplant recipients is less than that reported in kidney or heart transplant recipients, except when chronic kidney disease (CKD) is present at the same time. Data also suggest that viruric and viremic patients have higher levels of serum creatinine than BKV negative patients. Moreover, no specific immunosuppressive drugs are associated with the onset of BKV nephropathy. The comorbidity of transplantation and CKD could play a major role in promoting BKV replication.

Keywords: BK virus; Polyomavirus BK infection; Liver transplantation; Liver transplant recipients

Core tip: The prevalence of polyomavirus BK (BKV) infection among non-renal solid organ transplant recipients has been insufficiently investigated. Our review suggests that BKV viruria and/or viremia in liver transplantation is less prevalent than what has been reported in kidney or heart transplants, except when renal dysfunction is present. In general, viruric and viremic liver transplant patients have higher levels of serum creatinine. Therefore, renal dysfunction in liver transplantation may be an additional factor causing immunologic dysfunction that could make patients more susceptible to BKV infection.