Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2019; 7(3): 270-290
Published online Feb 6, 2019. doi: 10.12998/wjcc.v7.i3.270
Incidence, risk factors, and outcome of BK polyomavirus infection after kidney transplantation
Evaldo Favi, Carmelo Puliatti, Rajesh Sivaprakasam, Mariano Ferraresso, Federico Ambrogi, Serena Delbue, Federico Gervasi, Ilaria Salzillo, Nicholas Raison, Roberto Cacciola
Evaldo Favi, Mariano Ferraresso, Ilaria Salzillo, Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
Carmelo Puliatti, Rajesh Sivaprakasam, Roberto Cacciola, Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, United Kingdom
Mariano Ferraresso, Federico Ambrogi, Federico Gervasi, Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
Serena Delbue, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20100, Italy
Nicholas Raison, MRC Centre for Transplantation, King’s College London, London WC2R 2LS, United Kingdom
Author contributions: Favi E, data collection, data analysis, data interpretation, drafting the article, critical revision, and final approval; Puliatti C, conception of the study, design of the study, critical revision, and final approval; Sivaprakasam R, design of the study, data collection, data interpretation, critical revision, and final approval; Ferraresso M, data interpretation, critical revision, and final approval; Ambrogi F, data analysis, data interpretation, drafting the article, critical revision, and final approval; Delbue S, data interpretation, critical revision, and final approval; Gervasi F, data analysis, data interpretation, drafting the article, and final approval; Salzillo I, data collection, editing the article, and final approval; Nicholas Raison, drafting the article, language revision, critical revision, and final approval; Cacciola R, conception of the study, design of the study, data collection, critical revision, and final approval.
Institutional review board statement: This study was discussed in a regular Research Meeting at The Royal London Hospital and the consensus was that ethical approval was not required because of the observational nature and non-interventional study design.
Informed consent statement: Patients were all consented at the time of activation on the national transplant waiting list. They were aware that their anonymized data including viral status as well as other biomedical parameters would have been used for research purpose.
Conflict-of-interest statement: The authors do not have any conflicting interests.
Data sharing statement: Dataset available from the corresponding author at evaldofavi@gmail.com. Informed consent for data sharing outside formal research projects was not obtained but data are anonymized and there is no risk of patient details identification.
STROBE statement: The authors have read the STROBE Statement–checklist of items, and the manuscript was prepared and revised according to the STROBE Statement–checklist of items.
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/
Corresponding author: Evaldo Favi, MD, PhD, Senior Lecturer, Surgeon, Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza n. 28, Milan 20122, Italy. evaldofavi@gmail.com
Telephone: +39-2-55035603 Fax: +39-2-55035630
Received: October 31, 2018
Peer-review started: October 31, 2018
First decision: November 27, 2018
Revised: December 8, 2018
Accepted: December 12, 2018
Article in press: December 12, 2018
Published online: February 6, 2019
Processing time: 92 Days and 11.6 Hours
Core Tip

Core tip: Polyomavirus-associated nephropathy is a leading cause of kidney transplant failure. A systematic screening and treatment protocol in line with current international guideline was evaluated. Our results showed that despite early diagnosis and prompt intervention, graft-related outcomes for patients with BK-virus infection remain substantially inferior to control. We confirmed that initial viral load ≥ 10000 copies/mL is highly predictive of nephropathy. New putative risk factors for BK-viremia and nephropathy were also identified. Properly designed large multi-centre studies are warranted to further investigate individual susceptibility to BK-virus infection and validate alternative antiviral therapies.